Carrie Fisher's death puts spotlight on women's heart disease
Actress Carrie Fisher became a victim Tuesday of a threat to women that's bigger than cancer: Heart disease.
Cancer does kill a lot of women. Four of every 10 women who die between ages 45 and 64 die of cancer. But more than 1 in 3 women — 43 million — are living with cardiovascular disease, many without knowing it.
"Heart disease is the No. 1 killer of women and is more deadly than all forms of cancer combined," said Dr. Jennifer Mieres, professor of cardiology and population health at Hofstra Northwell School of Medicine in Hempstead, N.Y.
About once every minute a woman dies from a stroke, heart attack or a lesser-known problem called a sudden cardiac arrest, according to the American Heart Association. Sudden cardiac arrest differs from a heart attack. It's not caused by a blockage that stops blood flow to the heart; instead the heart's electrical system stops working properly and can't pump blood the way it should.
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Almost two-thirds of women who die suddenly from heart disease had no previous symptoms, according to the federal Centers for Disease Control and Prevention. And heart attacks seem to increase among women about 10 years after menopause — for reasons not entirely known.
“Women tend to have more atypical symptoms,” said Dr. Jay Stone, a cardiologist at Community Medical Center in Toms River, N.J. “A burning pain, shortness of breath or weakness, fluctuating in the chest or palpitations — it’s not the classic textbook that men tend to have.”
Ninety percent of all women have one or more heart disease risk factors, but the good news is that 80% of the problems can be prevented by controlling risk factors, according to the heart association. That means not smoking, exercising regularly, eating healthy foods, drinking little alcohol and maintaining proper weight.
“With most women, our focus is on our family, not ourselves,” said Loretta Impastato, 59, of Freehold Township, N.J. “With the last of my children getting married, I decided, ‘I’m overweight, my cholesterol is creeping up and I’m not feeling well. I have to do something.’ ”
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A stress test, echocardiogram and lab work determined that she was pre-diabetic and at a high risk for cardiovascular disease.
“It was the best thing that ever happened to me,” Impastato said. She could start doing something about the problem.
One way for women to stay on top of heart health is to know the target numbers:
• Blood pressure. High blood pressure can damage your heart as well as make you susceptible to stroke. Keep the systolic, top number, below 120 millimeters of mercury and the diastolic, the bottom number, at less than 80 mm Hg.
• Blood sugar. Diabetes — which results when the body doesn't make enough insulin or cells in muscles, liver and fat do not use insulin properly — can damage blood vessels over time, leading to heart disease. A glycated hemoglobin test indicates average blood sugar levels for the past two to three months. Less than 5.7% on the A1C test is normal. Another test measures blood sugar levels after an overnight fast. Less than 100 milligrams per deciliter of blood is considered normal.
• Cholesterol. One type, low-density lipoprotein, is considered bad because it transports cholesterol particles throughout the body to build up on the walls of arteries. LDL levels should be 129 milligrams per deciliter of blood or lower. High-density lipoprotein is the good cholesterol, transporting excess cholesterol particles back to the liver; HDL levels should be 60 mg/dL or higher.
• Triglycerides. This type of fat circulates in your blood along with cholesterol, storing unused calories to provide your body with energy, but too much may contribute to hardening of the arteries. Normal is less than 150 mg/dL.
"A study found that high triglycerides were a dangerous risk factor for stroke in women (but) not necessarily in men," said Charlotte Libov, author of books including A Woman's Guide to Heart Attack Recovery.
New research into gender differences in heart disease has had a positive effect on prevention and treatment strategies for women, Hofstra Northwell's Mieres said.
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"We have seen a decline in deaths from heart disease," she said. In the decade since the heart association's Go Red For Women campaign began raising women's awareness, a third fewer women have died from heart disease.
Smoking, high cholesterol, diabetes, a sedentary lifestyle, high blood pressure and obesity are risk factors for both sexes. But diabetes, lack of exercise and obesity are more potent risks in women, Mieres said.
Now researchers know that some risk factors — such as menopause before age 50, inflammatory diseases like lupus and rheumatoid arthritis, pregnancy complications and pre-term births — are unique risks to women, she said.
Pregnancy can be a stress test on the body's vascular system that gives doctors "a window into what may happen in the future," said Dr. Claire Boccia Liang, director of women's heart programs at Gagnon Cardiovascular Institute in Morristown, N.J. During pregnancy, high blood sugar, called gestational diabetes; high blood pressure; or preeclampsia, characterized by high protein in urine and high blood pressure, raise red flags for heart disease.
Women who live with chronic stress and those who sleep fewer than six hours a night have higher heart disease risk. Depression doubles the risk of heart attack, death or need for an artery-opening procedure in women age 55 and younger.
Family history also accounts for about 20% of heart disease risk, Boccia Liang said.
If a family member had a heart attack, stroke, bypass, stent or other major heart problem or procedure, the risk may be higher. The risk may increase at a younger age if the event happened to a parent or sibling before age 55 in men or 65 in women.
Both sexes can experience the classic heart-attack symptom of chest pain, but women instead can feel discomfort or pain in the neck, jaw, shoulder or right arm. They may feel unusually tired, short of breath, dizzy, lightheaded or nauseated and may vomit or sweat heavily.
Women's symptoms may mimic other conditions. For example, unusual fatigue could be the flu. Profuse sweating could be a hot flash. A sore jaw could be temporomandibular joint disorder, better known as TMJ.
If symptoms become worse when your heart works harder — you're running or walking fast, dancing or exerting in other ways — that's a tipoff to suspect heart disease, Boccia Liang said.
"Jaw pain that only relents with rest but gets worse with exercise is definitely a red flag," she said.
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Heart disease may seem unpredictable, but knowing the symptoms can help a woman stay alert, Libov said. Studies show that people whose heart attacks "seem to come out of the blue" were actually having symptoms up to a month before the attack.
And be aware that symptoms can sneak up. When a woman who always played two sets of tennis finds herself suddenly struggling to finish a game, "that's not normal," she said.
Don't blame aging or assume that a gradual decline happened because of lack of exercise, overwork, menopause, the blues or the blahs. It might be your heart's way of calling for help.
"We can't regenerate the muscle that's been damaged," after a heart attack occurs, Boccia Liang said.
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Six months after Impastato's screening and subsequent exercise and diet regimen, she returned for a checkup and the results were impressive.
Her total cholesterol level, once near 300 mg/dL, fell 65 points; 200 mg/dL or less is considered best. She lost 30 pounds and is no longer considered pre-diabetic.
“You don’t realize that you’re not feeling well until you start to feel well again, and now I feel fabulous,” she said. “I think everyone woman needs to have some kind of (cardiovascular) screening. With education, women are starting to understand more about this.”
Contributing: Jerry Carino, Asbury Park (N.J.) Press. A version of this story appeared in the Fall/Winter 2014 edition of USA TODAY's Best Years magazine.