More than 17,000 medical professionals gathered in Chicago this week to participate in the annual scientific sessions of the American Heart Association. Five days of comprehensive education focused on the fight against cardiovascular disease, the leading cause of death for men and women in developed countries. The scientific program, replete with late breaking clinical trials, new devices, drugs, acute interventions and guidelines for treating existing heart disease was comprehensive; fewer reports detailed ways to prevent heart disease. This is understandable given that those with existing heart disease are at higher risk for subsequent events and almost 50 percent of the decrease in deaths over the past three decades is attributed to secondary prevention with novel interventions, devices and medications.
The biomedical community, economists and health care professionals understand that prevention of heart disease can yield even greater benefits. Speaking to this point, we know that the likelihood of suffering from heart disease increases with age, but, even as older Americans experience better than a 20 percent decrease in heart attacks, hospitalization rates among young and middle-aged adults have not decreased. The effects of cardiac disease are not limited to the heart but touch social aspects of life. When young adults in their prime suffer the consequences of a heart attack or worse, the loss of life, the lives of thousands of families, many with young children, are upset and societal productivity diminished for years. Such life-altering events place an emotional burden on family members and friends and may necessitate lifestyle changes. Imagine this heart-rending situation among young people-- specifically young women. The fact is that young women (30 - 55 years old) hospitalized with a heart attack have higher death rates, more co-existing diseases, and longer hospital stays than men. Between 2001 and 2010, 30,000 of these women were hospitalized.
Whenever I talk to the young women in my office about heart attacks, I am struck with the care and concern they have for their loved ones. Uniformly, they are concerned about being good daughters, wives and mothers. They make sure that parents are on-time for medical appointments, that the men in their lives exercise and that their children learn healthy eating habits. I am also struck by an assumption they make -- they assume that heart disease won't happen to them. Unfortunately, they are wrong. Heart disease accounts for a remarkable 1 in every 4 female deaths -- almost 300,000 female deaths in 2009 and it is the leading cause of death for black and white women in the United States. Despite more than two decades of public health messages, however, only 54 percent of U.S. women recognize that heart disease is the leading cause of death for women. Compared to the year 2000 when just 34 percent of women recognized this fact, progress has been made. But, among minority and less-educated women, even fewer are aware. The lack of awareness can be fatal, making it harder to recognize symptoms of a heart attack: Women often don't realize that symptoms like neck, jaw or back discomfort, nausea and weakness are signs of a heart attack. As a result, they get emergency care more slowly, causing long-term adverse consequences such as arrhythmias, heart failure, and premature death. In the case of heart disease, knowledge is life-saving, and people who know about the risks are more likely to take preventive actions and adopt healthier lifestyles.
Now, there is a new list of risks for young women of child-bearing years and they are akin to a "stress test." For example, whereas most medical professionals will ask a woman if she has smoked, been treated for diabetes, high blood pressure, high cholesterol, or has a family history of heart disease, fewer ask if she was diagnosed with preeclampsia (very high blood pressure) during pregnancy nor do they advise her that preeclampsia significantly increases her future risk for a heart attack. Young women who take oral contraceptives and smoke are more likely to develop "early" heart disease. Those with depression have more than a two-fold chance of developing coronary heart disease. Equally troubling is that pre-pregnancy obesity is not only associated with the mother's increased risk for heart disease and stroke, but obesity also raises the risk for later-life cardiovascular events of her offspring.
An alarm is raised that younger adults, considering themselves at low risk or even no risk, will take part in behaviors resulting in the added health burden of obesity and diabetes. Rising rates of youthful obesity are alleged to account for life shortening between two and five years, and are expected to reduce U.S. life expectancy for the first time in two centuries. Because of the greater health burden of diseases that they will live with over many years, young women will benefit even more from aggressive efforts to identify and treat risks. In the short term, women who are not aware of healthy habits or take pleasure in lifestyles that give rise to heart disease (lack of exercise, unhealthy eating, smoking), may take exception to advice that encourages them to live otherwise. In the long term, however, reduction of heart disease will create conditions that are advantageous for these women and their families.
Efforts to reverse the recurrent trends require efforts of patients, the biomedical community, policy makers, health care providers and the media, all of whom should be aggressive and proactive about informing the public about the risks of heart disease for young women. But, progress is slow and appropriate materials designed for age, level of education and culture need to be made available. Moreover, we need to look into the sex-specific biologic, clinical and social issues accounting for the increased mortality, longer hospitalizations and greater health risks for young women. If we don't, the effects on young American women, and on the people who love them, will be, well, heartbreaking.
The author has no conflict of interest.
Elsa-Grace V. Giardina, MD, MS
Professor of Medicine
Director, Center for Women's Health in the
Division of Cardiology
Columbia University Medical Center
622 West 168th Street
New York, NY 10032
Phone: (212) 305-6154
http://www.cumc.columbia.edu/dept/cwh