Paying Special Attention to Cardiovascular Care for Women
Sara Macy knows she's one of the lucky ones.
It was 12 years ago that she woke up one Saturday morning feeling like she couldn't breathe. She went to the doctor and he suggested she had a bad case of nerves. Over the next week, she added a cough to her growing list of complaints and the diagnosis advanced to a virus.
But she kept getting worse. Back and forth she went to the doctor for several weeks.
Only after a chest X-ray revealed fluid in her lungs and she was sent for an echocardiogram did her true diagnosis come back-she had a blood clot and congestive heart failure.
Yet even after a four-week hospital stay that included having the equivalent of 22 pounds of fluid drained from her body and a diagnosis of type 2 diabetes to go with the congestive heart failure, Macy says, "I was actually happy."
She finally had an answer.
As she recovered by taking medications and learning to live a healthier life, she realized she was among a group of women with major heart and cardiovascular issues who are often misdiagnosed or not diagnosed at all.
"I think it's a predisposition,'' Macy says. "Some doctors get a mindset that women are going to have nerve problems. Men have heart problems.''
The problem of women not being correctly diagnosed with heart disease or cardiovascular problems has been slowly changing in the United States. Studies are showing that men's and women's hearts act differently, and that they might need different treatments.
"We're seeing, unfortunately, younger women having more coronary disease, and the mortality rate is climbing in this group,'' says Gretchen Wells, MD, the cardiologist with Wake Forest Baptist Health who diagnosed Macy's congestive heart failure and blood clot. "Why are these women as young as in their 40s dying?''
Wells will be leading a new Women's Cardiovascular Center that will open later this year at Wake Forest Baptist Health's Medical Plaza-Country Club.
The goal is to create a center that will:
- Educate women to lead healthier lives and avoid cardiovascular issues.
- Diagnose and treat women properly when they do face heart-related health problems.
- Be at the forefront of research that can lead to better solutions for women's cardiovascular problems.
"The response so far has been great with patients, women's groups and the community,'' Wells says. "I don't need to convince them.''
Differences in Symptoms
In a 2011 report, The Society for Women's Health Research and WomenHeart: The National Coalition for Women with Heart Disease noted that one in two women will die of heart disease or stroke, compared to one in 25 who will die of breast cancer.
The report suggested that more women should be participating in cardiovascular clinical trials, to help researchers draw accurate conclusions about the benefits or risks for women for a particular drug or device.
"Women are more likely than men to have delayed diagnosis and treatment due to heart attack symptoms that are overlooked or unrecognized,'' the report states. "Women also are less likely than men to receive cardiovascular diagnostic tests and are less often prescribed life-saving therapy with aspirin, beta-blockers or statins.''
Wells notes that the reasons for the differences women face from men with heart issues are still unclear in many cases.
"Elderly women get heart failure but it's different from the heart failure that (former vice president) Dick Cheney had, where the heart muscle function was reduced,'' Wells says. "Many elderly women have preserved heart function, yet they have signs and symptoms of heart failure. And we don't yet fully understand the reasons.''
Likewise, she says, women can show an abnormal result on a stress test, but then test negative on a catheterization, with the physician concluding the stress test was a false positive.
"But it's not necessarily a false positive,'' Wells says. "Women are at higher risk for cardiovascular events when testing abnormal on a stress test.''
David Zhao, MD, section chief of Cardiology for Wake Forest Baptist Health, says the Women's Cardiovascular Center is being created to attack just these kinds of issues. Education and prevention will be a key component of the center.
"We want to tailor that type of practice in the center; instead of chasing the disease, we need to try to prevent the disease in the population,'' he says.
The center will focus on educational programs for women as well as prevention. For women, the keys to preventing cardiovascular disease include maintaining a healthy weight, not smoking, exercising regularly and keeping blood pressure at a healthy level.
One benefit the Women's Cardiovascular Center will have is the research weight of an academic medical center. Women will be encouraged to participate in clinical studies and trials when appropriate. And research will be focused on areas of expertise.
Wake Forest Baptist Health cardiologist David Herrington, MD, says one strong area of research at Wake Forest Baptist is studying the problems that occur when the pumping chamber of the heart becomes stiff and is less able to maintain its function.
Picking Up on Women's Issues
Today, Sara Macy is retired after a career as an administrative aide with Wake Forest University. She enjoys spending time with friends, children and grandchildren and her black poodle mix, Sadie.
She is healthy and takes a regimen of pills to relieve her heart issues and type 2 diabetes. She says she has made a personal choice in the years since her problems were diagnosed to use women physicians. She doesn't hold anything against her former doctor, but believes women physicians are more compassionate.
"They're more likely to pick up on other women's issues,'' Macy says.
She says a center focusing on women's cardiovascular issues is a good thing because not everyone is as fortunate as she was in 2002 or as she is today.
"I know what to look for,'' she says. "People need to have an education about whatever's going on with their health.