October 27, 2020
Women's heart health

Photo: Ryan Ketterman

Dr. Pamela Ryan says the risk factors for women are not the same as those for men. It's important for a woman to focus on boosting their HDL or "good" cholesterol.

Executive Health

Women's heart health

The state's medical community is stepping up efforts to educate women about heart disease, which has become the No. 1 cause of death for women.

Dr. Samantha Avery joined the cardiology staff of the Heart Institute of St. Petersburg in July, becoming the only female in a group of 17 cardiologists.

That mix, and Avery’s presence, reflects the past and the present of heart disease. Once thought of as a man’s disease, heart disease has become the No. 1 killer of women, who account for nearly 50% of all heart disease deaths nation-wide. In Florida, heart disease and stroke account for 29.2% of all female deaths.

Many women who die of heart disease are older, but heart disease is the third leading cause of death among women 25 to 44 and second leading cause of death among women 45 to 64.

Lifestyle factors have changed: Women are waiting longer to have children and often take hormones. They are balancing work and family and make less time for exercise. The percentage of women who don’t exercise at all climbed from 19% in 1988 to 52% in 2010, according to a study by Stanford University published in the American Journal of Medicine. Their diets are often high in sodium and saturated fat. 

Avery says women often ignore the warning signs of decreased blood flow to their hearts. “Stress has become part of their daily lives. They might experience fatigue or anxiety, but they put off what they are feeling and go through the day.” 

She and other Florida cardiologists say women may experience different symptoms of heart disease than men — women, for example, may have a burning sensation in their upper abdomen, intense back pain, lightheadedness, an upset stomach and sweating, rather than the typical pain or pressure in the chest that men experience.

As a result, women and their medical providers may ignore symptoms that they are having a heart attack, attributing them to less dangerous causes such as aging, stress or the flu.

Doctors say this is particularly worrisome because heart attacks are generally more severe in women than in men. In the first year after a heart attack, 42% of women die compared to 24% of men, according to the Women’s Heart Foundation. 

Other aspects of heart disease, including risk factors, play out differently in women. Dr. Pamela Rama, a cardiologist with Baptist Heart Specialists and medical director of Baptist HeartWise in Jacksonville, says diabetes is a more deadly risk factor in women compared to men. “It increases the risk of a heart attack by five-fold, while in men it’s only two-fold,” Rama says. And, where high levels of LDL, or “bad” cholesterol are a strong predictor in men, low levels of HDL or “good” cholesterol, are a strong predictor in women, she says.

Another big indicator of future heart disease is behavior during pregnancy. Women who develop gestational diabetes, hypertension or preeclampsia during pregnancy have a 30% higher chance of developing heart disease later in life, Rama says. Menopause also is a factor, with research showing an increase in heart attacks among women about 10 years after menopause, possibly because of the decline in estrogen.

“For women, it’s very important to be in tune with your body,” says Rama.

Throughout Florida, the dynamics of heart disease have prompted the state’s cardiologists, hospitals and health centers to step up efforts to get women to pay closer attention to warning signs, particularly for women with known risk factors.

The campaign ranges from making emergency room doctors and nurses more aware of overlooked symptoms to communicating to female patients that their stressful careers may subject them to as high a risk for heart disease as men. Several hospitals around the state now have women’s heart centers and programs. Others are publishing dedicated newsletters on women’s heart health, offering free risk assessments, hosting ongoing workshops and putting on “go red” events In February in an effort to bring attention in their communities to women’s heart health.

Cardiologists are urging women, particularly those over 55, to have their cholesterol and glucose levels checked, blood pressure monitored and body mass index measured. BMI should be less than 25. “It’s important to know your numbers because it can help to detect your risk factors for cardiovascular disease in the earliest stages,” says Dr. Claudia Martinez, a cardiologist in Miami who is affiliated with Jackson Health System and the University of Miami. She urges all adults do a minimum of 20 minutes of cardio exercise a day for good heart health.

“We’re doing the education to get women to do the same prevention that men are doing,” she says.

Dr. Alvaro Gomez, an interventional cardiologist with the Miami Cardiac & Vascular Institute at Baptist Hospital in Miami, teaches about the additional risk in the Latina population. There are clusters of bad gene pools in the Latin population with intrinsically high levels of cholesterol despite what the women eat, he says. In addition, Latin American diets are often rich in starch and complex carbohydrates, which can create blockage of the coronary arteries.

“We’ve got to get these women To go get checked,” Gomez says. To educate them, he often speaks at community events and at free support groups for women who meet at Baptist Hospital in Miami.

Rama says risk factors like race, age and a family history of heart disease can’t be changed. But women can change or eliminate factors like weight, inactivity and smoking.

When a women’s numbers aren’t what they should be, doctors like Rashmi Schramm, a family physician for Baptist Primary Care in Ponte Vedra, urge patients to immediately make lifestyle changes such as cutting sodium and eating more fruits and vegetables as well as nonfat dairy products.

When women are diagnosed with heart disease, treatment ranges from medications such as statins, which reduce LDL cholesterol, to medical procedures that include angioplasty and bypass surgery. The type of treatment typically depends on how far along the Heart disease has progressed.

Medication may be part of the treatment, too. Schramm says advances in cholesterol-lowering medication are in trial stages, and injectable heart drugs may soon become a viable alternative to statins.

Nationally, heart health is getting attention: Clinical trials are under way for new medications, including a triglyceride-lowering drug. Statins with fewer side effects are rolling onto the market, new devices such as biodegradable stents are in development stages, and more surgeons are being trained in new procedures. In addition, there’s research under way around the country specific to women and heart disease.

“Right now we’re in a transition,” Gomez says. “The medical community has finally figured out they need to pay more attention to this. With all the advances, I still think the No. 1 thing that will make a difference for women is education.” 


Women usually develop heart disease about 10 to 15 years later than men because until menopause, the ovaries produce estrogen, which protects women against plaque buildup. But at menopause the ovaries stop making estrogen, and the risk goes up for women, who by age 70 have about the same risk for heart disease as sameaged men.

Family History

Women with a father or brother who developed heart disease before age 55 are at higher risk. Women with a mother or sister who developed heart disease before age 65 are also at higher risk. However, young women with a family history may not be aware of this risk and often are less careful about living a hearthealthy lifestyle than men with a family history.

Women’s Heart Health Facts

  • 8 million women in the U.S. are living with heart disease; 35,000 are under age 65.
  • For women under 50, heart attacks are twice as likely to be fatal than with men.
  • 71% of women experience early warning signs of heart attack with sudden onset of extreme weakness that feels like the flu. 
  • Women who smoke risk having a heart attack 19 years earlier than non-smoking women.
  • After a heart attack, women are less likely than men to receive beta blockers, ACE inhibitors and aspirin — therapies known to improve survival. This contributes to a higher rate of complications after heart attacks in women, even after adjusting for age.
  • While one in 31 deaths among American women each year is a result of breast cancer, one in three deaths is attributed to heart disease.
  • Heart disease claims more women’s lives each year than the next seven causes of death combined, and nearly twice as many as all forms of cancer combined.
  • Cardiovascular disease is the leading cause of death for African- American women.
  • Only one in five American women believes that heart disease is her greatest health threat.
  • Risk factors for women include physical inactivity, family history of heart disease, diabetes, irregular periods before age 45, specific complications in pregnancy, poor diet and high blood pressure.
  • Heart attack symptoms include stomach pain or nausea, shortness of breath, discomfort in areas of the upper body, such as shoulders, arms, back, neck, jaw or teeth, unexplained fatigue and sweating.
  • Symptoms in women may appear up to a month before a heart attack.

Source: Women’s Heart Foundation, American Heart Association, BaptistHeartWise.com 

Tags: Healthcare, Executive Health

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