By Susan Blumenthal, M.D. and Beth Hoffman
Today, Friday Feb. 3rd, National Wear Red Day, put on your favorite red sweater, dress or T-shirt and join in efforts to raise awareness about the No. 1 killer of women in America: heart disease.
While heart disease has long been considered an illness of men, it is in fact the leading cause of death for women in the U.S. Stroke, a condition caused by a sudden shortage of oxygen and nutrient delivery to the brain, ranks as the No. 3 killer for all people, and fourth for women specifically. Thanks to the triumphs of biomedical research and public health advances, the death rates from heart disease and stroke have declined by 60 percent since the 1950s.
Medications to treat high blood pressure and reduce cholesterol have played a significant role in lowering mortality rates, as has the decline in tobacco use in the U.S. The Centers for Disease Control and Prevention (CDC) hails the reduction in deaths from heart disease and stroke as one of the most significant public health achievements of the 20th century. Yet, even today, more people still die from these two diseases annually in America than from cancer, Alzheimer's, diabetes and kidney disease combined. In 2010, heart disease and stroke claimed the lives of more than 750,000 Americans. Those who survive acute attacks of these diseases can experience significant complications, with stroke ranking first as the leading cause of long-term disability among adults in the U.S.
Unfortunately, many people incorrectly assume that heart disease is primarily a disease of older men, and that cancer is the leading cause of death for women in America. But the truth is that heart disease is the leading killer of women in the U.S., and heart disease and stroke kill more women than the next five causes of death combined . Last year alone, cardiovascular disease claimed the lives of nearly half a million women, and according to the Women's Heart Foundation, when adjusted for age and other factors, the mortality risk from cardiovascular illness is 1.7 times higher in women as compared to men. Furthermore, the death rate for heart disease in men has decreased by 17 percent since 1979, but it has only declined by 2.5 percent over this same period for women . However, only 55 percent of women know that heart disease is their No. 1 killer, and less than half of women surveyed know what healthy levels are for determinants of cardiac health such as blood pressure and cholesterol levels . Even more shocking, more than 90 percent of primary care physicians don't know that heart disease kills more women than men each year .
In addition to raising awareness of heart disease in women, special emphasis must be placed on the health of minority and younger females. While one-third of Caucasian adult women are living with some form of cardiovascular disease, that number climbs to nearly 50 percent in African-American women . Furthermore, stroke incidence is rising dramatically among young and middle-aged Americans while declining in older people. A recent study presented at the Annual Meeting of the American Stroke Association reported a 17 percent increase in strokes among women 15 through 34 years old. This alarming shift in the age burden of this disease may be linked to the obesity epidemic in the U.S., which is a major risk factor for stroke.
These disturbing statistics are all the more tragic since both heart disease and stroke are largely preventable. Smoking, obesity, lack of physical activity, high blood pressure, diabetes and elevated cholesterol are all important risk factors that, when addressed effectively, can significantly reduce the risk of developing heart disease or experiencing a stroke. In fact, according to the National Stroke Association, simply lowering the risk factors for these diseases can prevent as much as 80 percent of heart disease and stroke in America. In addition, taking a daily aspirin has been shown to prevent a first stroke or second heart attack in women under age 65, and prevent a first or second stroke or heart attack in women over age 65 . Recent research, however, suggests that taking a daily aspirin to prevent a first-time heart attack or stroke may have more risks (such as serious bleeding) than benefits . Thus, it is important for individuals planning to start a daily aspirin to discuss this choice with their health care provider, as U.S. Preventive Services Guidelines currently recommend a daily aspirin for individuals at high risk of a heart attack only if their physician believes the benefits outweigh the risks.
While reducing risk factors is crucial to prevention, it is also important to raise awareness of the signs and symptoms of a heart attack or stroke so that women know when to seek medical care. A heart attack can be sudden and intense, but in many cases starts rather slowly, with mild discomfort. It is important to note that women may have a different symptom presentation than men, with more fatigue and indigestion rather than classic chest discomfort. This symptom presentation, combined with the misconceptions mentioned above, results in women being less likely than men to receive adequate screening and treatment, such as angioplasties and stents, for cardiovascular disease. Furthermore, relatively little research has been conducted on the effectiveness of drugs and medical devices specifically in women, meaning that physicians often do not know the effectiveness of a particular drug or procedure in women.
The goal of the Go Red for Women Campaign is to raise awareness about heart disease so that women can take the steps needed to protect their health. Looking to the future, increased investments are needed in basic science and clinical research to advance our understanding of how these diseases and their treatments uniquely affect women. In addition, another important step forward is education so that women can be savvy health consumers -- to learn about how to prevent these conditions by reducing risk factors, recognizing warning signs and entering into a partnership with their physician to promote better health.
Together, let's raise awareness of the No. 1 killer of women and make the elimination of heart disease and stroke one of the most significant public health victories of the 21st century!
Common Warning Signs of a Heart Attack:
Other symptoms include a cold sweat, nausea, severe indigestion, sense of impending doom and light-headedness.
For Stroke, a useful acronym to remember is "FAST"
Other warning signs of stroke may include sudden numbness or weakness on one side of the body, confusion, trouble walking, severe headache or difficulty seeing in one or both eyes.
For more information:
 American Heart Association: Go Red for Women. 2012. http://www.goredforwomen.org/about_the_movement.aspx. Accessed 11 Jan 2012.
 American Heart Association. Women and Heart Disease. 2012. http://www.heart.org/HEARTORG/Advocate/IssuesandCampaigns/QualityCare/Women-and-Heart-Disease_UCM_430484_Article.jsp. Accessed 11 Jan 2012.
 Daily Aspirin Therapy: Understand the benefits and risks. 17 June 2010. May Clinic. <http://www.mayoclinic.com/health/daily-aspirin-therapy/HB00073>. Accessed 22 Jan 2012.
 Joelving, Frederik. "Aspirin guidelines need overhaul, researchers say". Reuters Health. 9 Jan 2012. <http://www.reuters.com/article/2012/01/09/us-aspirin-benefits-idUSTRE80825720120109>. Accessed 22 Jan 2012.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, Chair of the Global Health Program at the Meridian International Center, and Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was named a 2010 Rock Star of Science by the Geoffrey Beene Foundation and GQ magazine.
Beth Hoffman graduated magna cum laude from Brown University. She is a medical student at the University of Pennsylvania School of Medicine and a former Health Policy Fellow at the Center for the Study of the Presidency and Congress in Washington D.C.
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