bittman heartattack

Heart Attack Survival in Women: an unfortunate stereotype

by Barry Bittman, MD

It never ceases to surprise me how some images seem to stick with us.

Consider the icon of a famous sneaker manufacturer and the gazelle-like young athlete who wears the product. Think about a night time cold medicine and the caring, calm and composed young mother tucking in her sniffling child. Imagine the typical heart attack victim and see the overweight gray-haired business executive clutching his chest and falling over at a corporate business meeting or during an argument.

You might be saying to yourself that such stereotypes are no more than mere advertising associations. It doesn’t take a stretch of the imagination to realize that out of shape weekend warriors wear Nikes, that mothers who care for ill children don’t always have every hair in place at 2:00 am, and that victims of heart attacks aren’t always older businessmen.

Yet in the medical field, such associations can sometimes be deadly¾ especially in the context of heart attacks and women. Let’s take a few moments to consider a fascinating study.

According to an October 1998 report in the Journal of the American Medical Association (JAMA), the death rate for women within the first month after a heart attack was more than double that of the male. Research including 331 women and 1,129 men under the age of 80 with a first heart attack demonstrated a death rate for women at 18.5% compared with only 8.3% for the men.

Dr. Nanette Wenger of Emory University School of Medicine noted:

§ The women were older.

§ The women had more associated diseases like diabetes.

§ The women did not receive the same intensity of care as the men.

§ The women did not receive the same follow-up care as the men.

§ The women were less likely to be referred early on for balloon angioplasty (to improve blood flow to the heart) or bypass surgery.

§ The women didn’t seem to realize they were at risk for heart attacks.

While one might assume from these statistics that heart disease is more lethal in women than in men, such is not the case. According to a 1998 study in the American Heart Association’s journal, Circulation, there is no gender difference in death rates for men and women who are hospitalized for angioplasty or bypass surgery. In fact, the 5-year survival rates for men and women after these procedures is virtually the same (88% and 87% respectively).

In order to more fully understand this data, consider the following facts from the American Heart Association:

§ Each year, 500,000 women suffer heart attacks.

§ 63% of women who died of a heart attack had no prior symptoms

§ 50% of women over the age of 55 are at risk for heart disease based upon elevated blood pressure alone.

§ 20% of women who have suffered a heart attack will experience a second attack within 4 years

§ Menopausal women who take estrogen are 50% less likely to develop heart disease.

Here’s the statistic, however, that’s most shocking. In 1995, 256,844 American women died of all types of cancer combined. This number represents less than one half the number of deaths attributable to heart disease! Now, compare the level of media coverage that breast cancer receives compared to heart disease in women.

It’s obvious that early diagnosis and education are the keys to preventing and effectively treating heart disease—especially in women. I’m proud to say that we are taking steps in the right direction.

Meadville Medical Center’s Heart to Heart cardiac rehabilitation program now includes the Mind-Body Wellness Center’s approach for risk factor reduction, nutrition and stress reduction— strategies that have been proven to improve quality of life while diminishing the risk of death. Coupled with a structured exercise program, every patient has the opportunity to experience a coordinated, whole person approach that simply makes sense.

While you might be concerned with the cost of the additional components, rest assured— there is none. The Commonwealth of Pennsylvania Department of Health has awarded us a 3-year grant to provide this comprehensive care free of charge to every patient in this program. Their support is also enabling us to provide our whole person component apart from the rehabilitation program for those who are at risk or who have strong family histories of heart disease or high blood pressure. This governmental awareness and support should be a great source of pride for every Pennsylvanian. It is now being transformed into improved quality of life for our community.

The following is a poignant perspective from a woman who completed our program. Her words paint a realistic picture of the challenges women face.

“I've always been ‘bubbly’ and that left after my heart attack and emergency surgery. It hurt when my daughter (who is 25) said, about one month after my heart attack, ‘mom will never be herself again.’ She would have been right if I would have still had all the fear, depression, etc. and didn't seek help. As for the sense of control in my life, it is all coming back in time. It has been a little over 3 months since my heart attack, but I'm gaining that confidence back again.

“If I would have skipped the Heart to Heart program, I would have missed a lot of help for all the problems and hurdles that come along with the package of having a heart attack and recuperation, not only the body, but the mind and spirit. I don't think I would be as far in recuperation if I would not have attended, and maybe never would attain my goal of getting my life back to as normal as possible.”

Life for Janet Hunter will never be same. She is one of those fortunate women who has a very different image in her mind about people who suffer heart attacks. It’s time we worked together to inform and educate women and men at risk, while ensuring the needed vigilance for early diagnosis and treatment. We can make a sizable difference when we take this to heart¾ Mind Over Matter!