In medicine, we were taught that women were protected against heart attacks until they went through menopause, and then our risks caught up with men's risks. But what if we weren't really protected that well?
How Heart Attacks Differ Between Men and Women
For many years, our research into the heart attacks has been focused on men. Even on TV and the movies, something awful happens, and a man clutches his chest and keels over. And we find if it's a police or a medical show, that he died of a heart attack. Most of us could have figured that out before the forensic pathologist told us on the TV show because we know what men's heart attacks look like.
In fact, we understood men's heart attacks and the causes, high blood pressure, smoking, eating red meat and fatty foods, and high cholesterol. Doctors really got on men's cases, and since 1960, men have decreased their smoking. And if their cholesterol or blood pressure is high, and their wives drag them into the doctor, the men were on blood pressure medications and cholesterol-lowering drugs. And meat and fatty foods, they're still Super Bowl yummies and fast food, and they're doing better.
Men's rates of heart attacks dropped dramatically. And then we noticed that postmenopausal women caught up with men in the rates of heart attacks at about 60. So we sort of got on it and started a national campaign, like the red dress for heart health, to help women understand their risks and the signs of heart attacks. But we were still thinking about women over 50, at least OB/GYNs were. And now comes a troubling study that shows that the rate of heart attacks in young people, people under 50 are increasing and are increasing more for women. This is worrisome. And it's important to look at the communities where this work was done and see what we can learn.
Increasing Heart Attacks in Young Women
From 1995 to 2014, the ARIC, A-R-I-C, Community Surveillance Study gathered information on almost 29,000 heart attacks. ARIC stands for Atherosclerosis Risk in Communities. And atherosclerosis is the clogging up of the arteries in the heart that can lead to heart attacks.
The communities that were involved in this study were in four geographic areas in the U.S. -- counties in North Carolina, Maryland, Mississippi, and suburbs of Minneapolis. Some of these counties have Americans at risk for heart attacks based on increased rates of diabetes, smoking, hypertension, obesity, and poverty in African American race. Of those 29,000 heart attacks, over the 20 years, one-third in what they called young people, people 35 to 54. Over those 20 years, the annual rate of young men's heart attacks went down some. But women's rates went up to the point that young women, pre-menopausal women had the same rate of heart attacks as young men. These data are alarming, and they mirror similar data from Canada, suggesting that the incidence of heart attacks in young women is rising.
Risk Factors Associated with Heart Attacks
Well, what are some of the risk factors for these young women? Smoking, high blood pressure, and diabetes very substantially increase the risk in women. And black women had very significantly more heart attacks than white women. Seventy-five percent of the young women with heart attacks had high blood pressure, 36 percent had diabetes. And women who had heart attacks were more likely to have multiple risk factors than men.
Young women who had heart attacks were less likely than young men who had heart attacks to have their cholesterol treated or their blood pressure treated. Young men and young women who had heart attacks had a 10% chance of dying the following year. Young women have some extra risk factors for heart attacks compared to men. They're more likely to have demonstrated risk for diabetes by being diabetic in pregnancy. They're more likely to demonstrate risk of hypertension and vascular disease by having preeclampsia when they were pregnant. And they are more likely to suffer the psychosocial stressors of poverty than men.
This information hurts my heart. These young women were mothers of young children and teens. They were at the most productive times of their lives, and they were also at the most stressful times of their lives. So what do we do with this information as women and as physicians? The risk factors in this study are ones that we all know about, risk for heart health, such as smoking, diabetes, and hypertension. But diabetes and hypertension often don't have physical symptoms.
Preventative Check-Ups for Young Women
Unless women are getting regular checkups, getting their blood pressure measured, their cholesterol measured, and their blood sugar checked, they may not know. Women used to go to their OB/GYN or their family doctor, get a Pap smear every year, but now they don't. Many women who used to go regularly for their checkups when they were having babies, don't go anymore. All clinic visits, for one reason or another, will have a blood pressure check, but cholesterol or diabetes checks aren't done so often in young women.
Of course, the big risk of smoking cigarettes in an unbelievable 48 percent of the young women who had heart attacks were cigarette smokers, would be addressed by the clinician, if women admitted to it. See our podcast on lying to your doctor.
So all women and men need access to health care. All the women and men need regular checkups at this very busy time of their lives, 35 to 54. All women and men need to have their blood pressure, high sugar, and high cholesterol managed according to national guidelines. And women need to take their medication.
How we manage the stressors of poverty, the stresses of being a minority are issues that we all need to address as a community and as a state and as a national level. So, ladies, please take care of your heart. And thanks for joining us on "The Seven Domains of Women's Health" on The Scope.
updated: September 5, 2019
originally published: February 7, 2014
