When it comes to heart disease, the No. 1 killer in the United States, we tend to think of older people at risk. The truth is, heart disease affects men and women, young and old, though the symptoms vary between the sexes. In fact, many times, doctors misdiagnose women because their signs and symptoms present differently from men.

Heart disease is a broad term that covers a variety of conditions affecting the performance of the heart. The most common condition is ischemic heart disease, also known as coronary heart disease or coronary artery disease. CAD is caused by poor blood supply to the heart, constricted by a buildup of fatty deposits (plaque) in the coronary arteries. The coronary arteries are the small, but important, vessels that supply blood to the heart. Consequences of ischemic heart disease include chest pain (angina), a heart attack or an arrhythmia. Chest pain can be caused by poor blood supply. A heart attack (myocardial infarction) occurs when the coronary artery is completely blocked. When that happens, part of the heart muscle is deprived of oxygen which can lead to permanent damage. An arrhythmia is a disturbance in a normal heartbeat.

Women with heart disease often show signs of diffuse plaque buildup and diseased smaller arteries. These symptoms are more subtle than the crushing chest pain often associated with a heart attack and also can relate to a condition called endothelial dysfunction, a malfunction of the lining of the artery. When that happens, the lining of the artery will not expand properly to increase blood flow during activity, thereby increasing the risk of coronary artery spasm and sudden death.

Women, and some doctors, may mistake the signs of a heart attack for symptoms associated with a viral infection or the flu. A misdiagnosis resulting in delayed treatment can allow time for significant damage to occur. In addition, standard testing for CAD — angiograms and treadmill testing — may leave some women with a false sense of security. The Women’s Ischemic Syndrome Evaluation study showed that in some women, plaque accumulates as an evenly spread layer along artery walls which may not be visible using traditional testing methods designed to identify the bulky, irregularly shaped plaque in men’s arteries.

The WISE study is the first undertaken on women with chest pain. Historically, CAD has been viewed primarily a man’s disease. Recent statistics show that the rate of heart disease has declined in men, but not in women. This may be due to gender differences in risk factors, symptoms and diagnostic accuracy. Although traditional risk factors for CAD such as high cholesterol, high blood pressure and obesity have a harmful impact on men and women, certain factors may play a bigger role in the development of heart disease in women. For example, mental stress and depression affect women’s hearts more than men’s. Metabolic syndrome, a combination of increased blood pressure, elevated blood glucose and triglycerides, also has a greater impact on women than on men. Also, according to the WISE study, smoking is much worse for women than for men. To further complicate matters, low levels of estrogen before menopause increase a woman’s risk for developing microvascular disease.

Women with microvascular disease may need medication to control such underlying risk factors as high blood pressure, high cholesterol and high blood glucose. Women need to be vigilant about recognizing and treating their risk factors. Do not wait until you have been diagnosed with an artery blockage or have symptoms. If you have a considerable number of risk factors for CAD, see your doctor. If your doctor is not taking you seriously, get a second or even third opinion.

Feb. 2 is National Wear Red Day, an annual event to promote awareness of heart disease, particularly in women. Awareness, education and prevention are essential to saving lives. Inform your mother, sister or daughters about their risk for heart disease. For more information, visit www.americanheart.org or www.reddresscampaign.com.

Preventive Care

Stay informed about cardiovascular disease
Get regular health screenings
Do not smoke or use tobacco products
Reduce your stress and, if depressed, get appropriate treatment
Eat a heart-healthy diet and maintain a healthy weight
Be physically active; exercise, exercise, exercise