When actress and comedian Rosie O'Donnell suspected she was having a heart attack in 2012, she ignored the symptoms, took some aspirin and didn't call a doctor until the next day. Her reaction, health experts say, is all too common for women, who often dismiss heart attack symptoms, and emergency medical technicians and doctors who don't take them seriously enough when they see them.
In the last few decades, physicians have tried to educate women that their risk for heart disease is just as great as men's. One in three women in the U.S. will experience some form of it, and many of them won't be as lucky as O'Donnell. Women are much more likely to die after having a heart attack than men — 42 percent will die within a year after an attack, compared to 24 percent of men, according to nonprofit The Heart Foundation. Heart disease, the No. 1 killer of women (and men) in the U.S., causes more deaths than all cancers combined.
But despite efforts to raise awareness about women's risk, the message hasn't gotten through as much as doctors would like.
“I'm always amazed that women are still surprised by this,” says Dr. JoAnne Foody, director of cardiovascular wellness at Brigham and Women's Hospital in Boston. “To many people, the typical heart attack victim is still a 50- to 60-year-old man, maybe a smoker, having crushing chest pain.”
In fact, the death rates from heart disease for younger women — 35- to 54-year-olds — are actually increasing. One of many reasons for this is that many people are unfamiliar with common signs of heart attack, particularly for women. Although 92 percent of respondents to a 2005 poll recognize chest pain as a sign of a heart attack, only 27 percent were familiar with the other common symptoms and knew to call 911 when they saw them, according to the Centers for Disease Control.
This lack of knowledge is more problematic for women, for whom sharp chest pains during a heart attack are much less common. Women-specific heart attack symptoms include pain in the arm, jaw or back; stomach pain; shortness of breath; and fatigue.
“Forty percent of women experiencing a heart attack won't have chest pain,” says Holly Andersen, director of education and outreach at the Ronald O. Perelman Heart Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “Women are more likely to have small-vessel disease in microcirculation, which we won't typically see on an angiogram. It's harder to find.”
Studies have found that EMTs and doctors are slower to respond to women who are suffering heart attacks, in part due to the misconception that women don't suffer as many as men do and a lack of understanding about how women's symptoms of a heart attack differ. And women themselves, like O'Donnell, are much less likely to call 911 even when they suspect they're having a heart attack. “I've had female patients having real cardiac incidents who have actually apologized to EMTs for calling,” Andersen says.
In addition, women are more reluctant than men to take heart medications and more likely to say that they don't have enough time to make the lifestyle changes, such as following a heart-healthy diet and exercising, due to family obligations, according to Foody.
The good news is that simple steps to improve your heart health can dramatically reduce your risk.
The most important thing you can do to slash your risk is to quit smoking. Doctors also recommend following a Mediterranean-style diet – cutting out high-fat dairy and processed foods and eating fresh fruit, vegetables, whole grains, lean protein and omega-3-rich fish – and getting at least 20 minutes of moderate exercise, such as brisk walking, every day.
”Exercise lowers your risk by keeping arteries flexible and healthy, so they're resistant to cholesterol buildup in blood vessels,” which contributes to the development of heart disease, says Nieca Goldberg, medical director of the Joan H. Tisch Center for Women’s Health at the New York University Langone Medical Center.
Exercising daily also helps you sleep better at night and relieves stress, which decreases your risk for heart disease, Andersen says. Another important step: Be proactive and ask your doctor about your risk.
“It's particularly important if you have a family history,” Foody says.
Some final advice: Indulge in a piece of heart-healthy dark chocolate now and then, and have sex, which relieves stress and gets oxygen circulating, says Andersen. Who says a heart-healthy lifestyle has to be boring?