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What Women Need to Know
By the time Cindy Steger's heart attack was finally diagnosed, she was in bad shape. She had one thing going for her, though: Because she'd been an avid exerciser, her body had been silently compensating for the gradual obstruction of her blood vessels by shunting blood to smaller veins. That "collateral" vascular network was a lifesaver when a clot blocked her artery. "My cardiologist told me that if I hadn't led the kind of lifestyle I did, I wouldn't have survived," she recalls.
Though Steger's heart lost about 20 percent of its power in the attack, she quickly began pushing herself to get back into shape. Now, while she still gets winded easily, she's back to competing in racewalks. But her story highlights several of the special dangers women face when it comes to their heart. First is ignorance-their own and sometimes their doctors' too. In a 2004 study, fewer than one in five physicians knew that more women than men die each year from heart disease. Even in the emergency room, women wait longer than men for an EKG, and they're less likely to get blood-thinning drugs.
Making matters worse, the gold standard test for people complaining of chest pain is less reliable in women. The coronary angiogram -- in which dye is injected into the heart's arteries and an X-ray is taken-does a good job of detecting blockages. But it turns out that while men with heart disease generally get concentrated buildups of plaque, women's artery-clogging muck is often more diffuse and therefore less noticeable. What's more, their smaller coronary arteries-the twigs on the arterial tree-can fail to dilate when they should, further restricting blood flow. As many as 3 million American women suffer from this problem, according to cardiologist C. Noel Bairey Merz, MD, at Cedars-Sinai Medical Center in Los Angeles. So even if a woman gets an all clear from an angiogram, she should get treatment if she has symptoms.
There are also some special considerations for the woman who's healthy and wants to make sure she stays that way. First, she shouldn't smoke-no one should, but the habit is even harder on a woman's heart than it is on a man's. And if a basic checkup leaves her uncertain about her level of risk, she might want to ask her doctor about a special test called an ankle-brachial index (ABI), says Ezra Amsterdam, MD, professor of medicine at the University of California, Davis, School of Medicine.
It's a simple exam: A doctor just measures blood pressure at the ankle and the arm and compares the results. If the pressure is significantly lower at the ankle, it suggests that blood is having a hard time getting through sludged-up or stiff vessels. Why it's worth doing: Conventional risk factors sometimes fail to identify women heading for heart trouble, and adding the ABI can help, an international review of studies found last year. (The ABI also helps spot men at risk but doesn't make as big a difference.)
Finally, women who find that they are at risk should talk to their doctor about taking a statin. That decision has long been difficult for women: Even though these top-selling cholesterol busters have helped millions of high-risk men reduce LDL by 30 to 50 percent, halt the buildup of plaque, and slash the danger of heart attack and death, there's been scant evidence that they help high-risk women.
But a massive study known as the JUPITER trial may sway opinion. Involving nearly 18,000 volunteers from 26 countries, the study tested the idea that statins might help people whose blood tests showed increased levels of inflammation, even if their cholesterol levels were normal. The double-barreled results: Lowering levels of a protein called CRP, or C-reactive protein, a marker of inflammation, seems to be protective even when cholesterol levels are okay. And both women and men benefit. Indeed, statins halved the risk of cardiovascular disease. However, the volunteers were followed for only a couple of years, on average, and the study can't guarantee the long-term safety of the approach. So it's worth noting that a healthy diet and exercise also reduce cholesterol and CRP.
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