By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Public Health Promotion Specialist
Every February the American Heart Association (AHA) brings intensified awareness to the high rate of heart disease in men and women in this country.
While some of this disease burden is attributable to genetics and factors beyond our control (e.g.: we can’t choose our parents) much of the increasing numbers of people with acquired heart disease are the result of the lifestyle choices we make, and that are within our control.
The aim of the various Heart Month Campaigns is to help people become aware of life-style risk factors as well as those factors that are associated with our being born into a specific race or culture, being born male or female, and of our age at any point in time. We all need to know and understand our own risks. There are factors we can manage or eliminate from our unique risks, such as controlling our high blood pressure, diabetes, and cholesterol levels with diet and medications, not smoking or vaping, and controlling our weight through diet and exercise. The risk factors you cannot control are advancing age, your genetic gender, the health history of the family into which you were born, your race, and your past history of a heart attack or stroke.
COVID has added a new dimension. A huge study conducted through the V.A. identified a substantial and long-term rise in the risk of cardiovascular disease in the year following a SARS-Co-V-2 infection. A glaring increase in 20 cardiovascular problems was detected during the year following even a mild COVID infection. The risk of heart failure alone in that post-COVID year was increased by a whopping 72% (Xie, Xu, Bowe, & Al-Aly, 2022, Nat Med).
We generally think of those having heart attacks as being older people. While this is generally true, young people,including children are not immune to heart disease. Some of us are born with cardiac abnormalities, but others,even as children, place additional strain on our hearts as a result of engaging in avoidable risky behaviors such as over eating, making poor food choices, being inactive, substance use and misuse, and not recognizing the warning signs of a heart problem. Over-exertion during sports and becoming dehydrated can lead to cardiac arrhythmias, even in youths. An arrhythmia is when your heart beats irregularly. This can happen at any age. When it persists, your heart can stop beating. The AHA recommends that a medical history (including family history) and a physical exam be done before participating in sports at any age. Adding an EKG can detect heart and heart rhythm disorders that an exam alone will not always reveal. When athletes at any age have no observable symptoms to report during an exam or health history, a diagnosis can be missed; 60-80% of athletes who suffered sudden cardiac death had no prior symptoms (Sudden Death in Young Athletes Verywell Health, Oct 24, 2021).
More women die of cardiac disease than they do from all forms of cancer
Women, and particularly women of color, have been historically under-represented in cardiac research studies over many years. Now we know that cardiovascular disease is the number one killer of women. It takes the life of 1 in every 3 women annually. For women of color, cardiovascular diseases take an even higher death toll; nearly 50,000 African American women die of cardiovascular illnesses every year. Of those over 20 years old, 49% have heart disease, but only 20% (1 out of 5) African American women believe she, personally, is at risk. Just slightly over half know the signs and symptoms of a heart attack, and only around 2/3 of them realize that heart disease is their greatest health risk. If you can’t recognize a heart attack in progress, your chances of survival drop (AHA, 2022).
The AHA identified that on average, Hispanic/Latino women are likely to develop heart disease a decade earlier than non-Hispanic women, yet only 1 in 3 Hispanic women realize that heart disease is their number one killer. The AHA reported that Hispanic/Latino women are 38% more likely than all other racial groups to take heart-healthy preventative action for their families, but they completely ignore their own health in the process. This is a cultural practice that warrants change borne of knowledge (AHA, 2022).
Heart disease in women presents differently than in men. Women have unique biological factors that men do not experience; monthly hormonal fluctuations, carrying and nurturing a growing child, and the added stress that months of pregnancy followed by delivery places on the mother, and women’s cardiovascular risk-factors increase again as they go through menopause. More than half of all high blood pressure deaths occur in women and this is higher in Black women. High blood pressure (a cardiovascular disease) is called the silent killer because it shows no symptoms, yet it results in both heart attacks and strokes (sometimes referred to as “brain attacks”). As a most unfortunate sign of our times, a woman who has a cardiac arrest in public is less likely to be given CPR by a by-stander due to fear of accusations of inappropriate touching or sexual assault (AHA, 2022).
Knowing your risk factors, controlling the ones you can, and recognizing the signs of a heart attack is essential for everyone. Acting upon that awareness can mean the difference between life and death. These signs can be different for men and women. Common symptoms are jaw, neck or back pain, nausea and vomiting, and feeling short of breath. Men often experience a crushing or squeezing chest pain (like an elephant sitting on their chest) while many women feel no chest pain at all. Women often feel faint, feel like they have indigestion, and feel extremely tired. If these symptoms appear prompt action is needed. Call 911. DO NOT drive yourself to the hospital or have others drive you to the hospital. The ambulance is an E.R. on wheels, and lifesaving action may be needed at any moment. Denial that one is actually having a heart attack is extremely common. Don’t die from denial and don’t let someone else die because they are in denial. We all should learn and be able to give CPR in an emergency.
Video & Articles on Heart Disease:
Heart to Heart: Why Losing one Woman is Too Many
Symptoms of a Heart Attack in Women and Men
Heart Disease in African American Women
Heart Disease in Hispanic Women
Understanding a heart attack: Signs and Treatments
Heart-disease risk soars after COVID — even with a mild case