While many women receive regular mammograms and Pap smears, they often overlook the tests that monitor heart health. Cancer remains a large concern, to be sure, but the discrepancy is striking when you consider that heart disease is actually the leading killer of women—of all ages.

“One in 30 women will die of breast cancer, but 1 in 3 will die of stroke or heart disease,” says Diana Rinkevich, director of the Heart Disease in Women program and director of the Cardiology Outreach CMH-OHSU program.

The lack of heart health monitoring owes to a variety of factors, she explains. First, women are less likely to be aware that they have heart disease: although chest pain can be a common sign, other symptoms occur more often in women than in men. They include upper abdominal pain; heartburn; shortness of breath; neck, back, or jaw pain; nausea; dizziness; and fatigue. Women don’t often attribute symptoms like these to heart disease, Dr. Rinkevich says.

 

 Second, women may differ from men in the type of heart disease they experience. For example, coronary microvascular disease (MVD), a condition that affects the heart’s smallest arteries, afflicts women’s hearts more than men’s. In coronary MVD, the walls of the heart’s tiny arteries don’t relax properly and can spasm. Even though women with this condition have insufficient blood and oxygen flow to the heart, a standard angiogram (which is designed to show blockages in large arteries) is likely to show their arteries to be normal.  Many researchers attribute coronary MVD to traditional risk factors for heart disease—along with the drop in estrogen levels during menopause.

“Once a woman reaches menopause, her risks of heart disease and heart attack jump dramatically,” Dr. Rinkevich says. “One in eight women between the ages of 45 and 64 has some form of heart disease, and this increases to one in four women over 65.”

But heart disease can be a factor at any age, she cautions. That’s why you need to know your own risk factors for heart disease (e.g., smoking, cholesterol, eating habits, family history). Screening tests are different for each woman; for example, an EKG or stress test for everyone isn’t cost effective. It’s also important not to be complacent: Not having diabetes or hypertension doesn’t equate to good heart health, Dr. Rinkevich says. You need to know your numbers:

 

  • Blood pressure: Should be less than or equal to 120/80.
  • Body Mass Index (BMI): Should be in the range of 18.5–25. 25–30 is overweight, and over 30 is obese.
  • HDL: Otherwise known as your “good” cholesterol, this should be 50 milligrams/deciliter (mg/DL) or above.
  • LDL: The “bad” cholesterol—this should be less than 100 mg/dL.
  • Triglycerides: Less than 150.
  • Fasting blood sugar: Less than 100.
  • Exercise: 150 minutes a week minimum of moderate exercise (for example, 30 minutes of walking over five days).

  

 

Several risk factors appear to be more aggressive in women, Dr. Rinkevich says. For example, stress and depression affect women’s hearts more than men’s. Depression also makes it difficult to maintain a healthy lifestyle. Smoking is a risk factor for both women and men, but it appears that the risk is even greater for women smokers. Also, a condition called metabolic syndrome—a combination of fat around the abdomen, high blood pressure, high blood sugar, and high triglycerides—has a greater impact on women than on men.

Women are also less likely to seek help; recent research shows that women may have symptoms for a month or longer before seeing a health care provider, and by that time, their hearts are already damaged.

“Some women think heart disease can be ‘cured’ by surgery—that’s a myth,” Dr. Rinkevich says. “Heart disease is a lifelong condition: once you get it, you’ll always have it. True, procedures such as bypass surgery and angioplasty can help blood and oxygen flow to the heart more easily, but the arteries remain damaged, which means you are more likely to have a heart attack. What’s more, the condition of your blood vessels will steadily worsen unless you make changes in your daily habits. That’s why it is so vital to take action to prevent and control this disease.”

The good news, according to Dr. Rinkevich, is that heart disease is preventable. “It’s never too early to get regular checkups and talk to your health care provider about heart disease,” she says. “Women need to be proactive in asking questions, sharing their risk factors, and making healthy choices.”

In addition, while for years heart disease studies primarily involved men, women’s heart research is showing signs of progress. At OHSU, the Women’s Heart Program offers research and technology including myocardial contrast echocardiography to test for coronary MVD.

Womens Health Annual