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H EART DISEASE IS the leading cause of death for women in the United States. Among all U.S. women who die each year, 25 percent die of heart disease, according to the US Department of Health and Human Ser vices, Office on Women's Health. The majority of those who die, 64 percent according to the Centers for Disease Control, have no prior symptoms — their first symptom is death. That is why it is so important for phy- sicians to educate their female patients about the incidence of heart disease in women. Women need education on the risk factors, the symptoms, and the need to seek prompt medical attention if symptoms arise. Regular screenings and check-ups are imperative. It is important for women to "know their numbers" for blood pressure, choles- terol, and glucose. Risk factors for women are the same as for men. Diabetes, high blood pres- sure, elevated lipid levels, and smoking are the major risk factors. Obesity, poor diet, inactivity, and excessive alcohol consumption further increase that risk. As with men, family history plays an important role. According to the U.S. Department of Hea lth and Human Ser vices, a woman whose father or brother had a heart attack before the age of 55, or whose mother or sister had a heart attack before the age of 65, has a higher risk of developing heart disease. The symptoms of coronar y heart disease may be different in women than men. While classic anginal symptoms of crushing chest discomfort radiating to the jaw or arms may be experienced, women often experience more non- specific symptoms. A vague tightness in the chest, abdomen, or back may be reported. D yspnea, fatigue, and exercise intolerance or nausea may be the only symptoms. These symptoms may occur intermit- tently for hours, days, or even weeks. Such was the case of a 38-year-old fem a le p at ient who e x p er ience d intermittent bouts of nausea, upper abdominal discomfort, and shortness of breath on exertion for several days before visiting an urgent care center. As the patient was a young female, and the presentation nonspecific, the symptoms were felt due to a viral syndrome and she was discharged to home. A week later, she presented with more intense symptoms to the hospital Emergency Department. Further testing, including a cardiac catheterization, demonstrated that previously undiagnosed diabetes a nd hy perlipidemia had led to the development of multi-vessel coronary artery disease. The patient underwent coronary bypass graft surgery and was initiated on aggressive medical therapy for her risk factors. This patient was a working mother of two children who considered herself to be "healthy" even though she was a smoker. For this reason, she had not seen her primar y care physician for three years. Although her father had heart disease, she thought she was immune because she was a woman. As w ith a ll diseases, ea rly detec- tion and treatment of heart disease improves outcomes. Education is essen- tial. Female patients need to be made aware of the high incidence of heart disease in women, as well as the risk factors and symptoms of heart disease. The importance of regular check-ups and a healthy life-style needs to be emphasized. Women need to know when to seek care urgently. Greater awareness of these issues can empower women to live healthier, and perhaps, longer lives. D r. Mich a el B a g e i s a b o ard- c e r- tif ied cardiolog ist who is certif ied in Echocardiog raphy. He is a member of Wester n Reser ve Hospital Physicians Cardiolog y, with offices in Cuyahoga Falls and Green, and ser ves as Division Chief, Cardiolog y, at Western Reser ve Hospital in Cuyahoga Falls. ■ Heart Disease Is the No. 1 Killer of Women — SPREAD THE WORD By Michael D. Bage, MD, FACC +++++++++++++++++++++++++++++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++++++++++++++++++++++++++++ SPECIAL CLINICAL SECTION: WOMEN'S HEALTH ❯ 1 4 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ S E P T E M B E R /O C T O B E R 2 0 1 4