No crushing chest pain came with Lani Barao’s 2008 heart attack. When a doctor asked her to rate her dull pain on a scale of one to 10, she called it a four—well below the 10 of labor contractions.
Barao was in her late 30s, a runner and a busy stay-at-home mother of two when she began experiencing tingling in her arm, heavy sweating and a stomachache while driving with her young daughter. The Virginia Beach, Virginia, resident pulled over and called her mother, a former nurse who convinced her to go to a hospital just to be safe.
“I was thinking maybe I ate something weird,” says Barao, now 45. “When a doctor told me I was having a heart attack, I said, ‘Are you serious?’ My symptoms were nothing like what I would put with a heart attack.”
In fact, Barao was a perfect example of one major reason why heart disease has been the leading killer of American women for decades. Many women—and even many physicians—aren’t aware that symptoms often differ from the classic chest and arm pain seen in men. They tend to be slower to seek help or, when they do, to receive potentially life-saving diagnoses, medications and surgeries. Barao was lucky to have her mom’s advice and doctors who inserted two stents to restore blood flow, sparing her heart any damage. Her previously healthy lifestyle also aided her recovery.
Coronary heart disease is responsible for one in every three women’s deaths each year in the United States—more than 290,000 people, which tops all forms of cancer combined, according to the American Heart Association and the Centers for Disease Control and Prevention. A nearly equal number of women and men die, but heart attacks are more often fatal in women (who generally are older and frailer when they strike). And while overall death rates from heart disease have fallen with better prevention and treatments, they are falling more slowly in women.
Awareness that heart disease is not a “man’s problem” is growing: 56 percent of women now know it is their number one killer, compared to 30 percent in the late 1990s, AHA surveys show. Yet many women remain far more fearful of cancer, especially breast cancer (which kills about 40,000 women annually).
“The stereotypical male clutching his chest is much more prominent in people’s minds,” says Dr. Robert Lancey, medical director of Cardiovascular and Thoracic Services of the Heart and Vascular Institute at Maryview Medical Center in Portsmouth, Virginia. “That bias might have fallen off some in the last 15 years, but it’s not gone. Too often, women’s symptoms are discounted as something other than heart disease.”
Although two in three women recognize chest pain as a heart attack symptom, just one in 10 realize shortness of breath and nausea are potential signs, Lancey says. Women also may suffer from vomiting, dizziness, profuse sweating, unexplained fatigue and neck, jaw, back, or abdominal pain. Many have no symptoms before a heart attack. Even if they do, they may get an incorrect diagnosis, especially since heart function tests can be less accurate in women.
Some risk factors are identical in both sexes, including high blood pressure and cholesterol, diabetes, smoking, obesity, inactivity, poor diet, stress and heavy alcohol use. Others are unique to women, such as combining cigarettes and birth control pills or developing high blood pressure, diabetes or increased obesity during pregnancy. Depression seems to take a heavier toll on women’s hearts, and they apparently need higher levels of “good” cholesterol to protect their arteries (Barao, for one, didn’t have enough of that type of cholesterol).
On the plus side, estrogen seems to have a protective effect; more women develop heart disease after menopause, an average of five to 10 years later than men, says Dr. Dilip Sarkar, who retired as a vascular surgeon and Associate Professor of Surgery at Eastern Virginia Medical School after a heart attack and bypass surgery in 2001. But younger women are by no means immune—and they’re often the worst at seeking quick medical attention.
“We notice all the time that women are so busy taking care of everyone else that they don’t take care of themselves,” Sarkar says. “If you’re feeling symptoms, don’t try to fix your husband dinner or put your kids to bed before you go for help.”
Quick action is what saved Teri Arnold, a 43-year-old Chesapeake, Virginia, resident. Arnold is a vegan, exercises regularly and has normal blood pressure and cholesterol and no strong family history of heart disease. She smoked sporadically after college but quit for good six years ago. She also happens to be director of marketing and communications for the American Heart Association’s Mid-Atlantic affiliate.
Early one morning last October, Arnold woke up with chest pain. When she stood up, she felt lightheaded and sweaty. “Then I felt the nausea,” she remembers. “I said right then, ‘I’m having a heart attack.’” Her partner called 911 and she chewed two aspirin before an ambulance arrived. “If I didn’t know the signs so well, I probably would have gone back to bed,” she says. Doctors are unsure what caused her attack, which left her with minimal heart damage, but lingering fatigue, chest discomfort and shortness of breath. “It’s scary,” she says.
It really has shown me how much more research we need, because doctors often don’t know what to do to help women.”
As the nation’s population ages and the percentage of women increases, heart disease could exact an even more devastating statistical toll. Yet campaigns such as the AHA’s Go Red for Women campaign (goredforwomen.org) are gaining steam, and many Baby Boomers are determined to stay healthy and active, Lancey says. Research also is advancing on better gender-specific treatments.
Women can protect themselves by watching portion sizes, limiting processed foods, exercising for 30 minutes most days of the week, managing stress, aiming for seven to eight hours of sleep a night, avoiding cigarettes, keeping alcohol use to a drink a day, learning their family history and getting annual checks of blood pressure, cholesterol and blood sugar levels. “This is a preventable disease,” Lancey notes. “We have the power to tell a different story, because we know what causes it.”
Lani Barao, who survived a second heart attack just before turning 40, also prefers to focus on the positive. With proper medication and stents, she is now strong enough to run half-marathons and strives to be a role model on fitness, nutrition and proper rest for her family. “I emphasize hope,” she says. “Every woman needs to be her own best advocate.”
