When I went to the hospital with chest pain five months after my sixtieth birthday I became a statistic: one of nearly a half-million women who present such symptoms at ages 50 and beyond; but fortunately, not as one of the nearly quarter-million who die of heart disease each year. Alert to my body symptoms and not in the least machismo about getting medical help when I need it, I was in the emergency room within 30 minutes of my first symptom.

This was too soon to show elevated enzymes in the blood which would have confirmed miocardial infarction taking place even then, and, for one who has experienced dozens of hospitalizations, including several childbirths and major surgeries as well as traumatic injury, not in such severe pain everybody attending me seemed relatively unconcerned. The cardiologist covering for my doctor wrote up an order for gall bladder testing for the next morning, despite my insistence that this seemed like a heart attack to me, although apparently my electrocardiogram did not convince the attending physicians.

Twelve hours or so later, around midnight on a Sunday evening, elevated enzymes in my blood revealed the truth, and my morning I was scheduled for an angiogram to reveal the coronary artery damage and to plot a course of action. At no time was I offered clot-busting medication. Even after it was revealed that I had four blocked arteries, I had to wait nearly 48 hours for the surgery that would hopefully restore my cardiac health and leave me (only) a permanently scarred, heart-muscle-damaged, arterial graft-carrying woman—if I survived the surgery. I did survive, but with 30% damage to the heart muscle and I’m still wondering what would have been my fate had I been a 60-year-old male with the same presenting symptoms?

For a long time a dearth of coronary studies involving females revealed the medical community’s blissful ignorance of the seriousness of heart disease in women, as well as men. In fact, the Harvard Heart Letter, from Harvard Medical School, shows that more American women than men die of coronary disease and stroke each year—479,000 compared to 447,000!

Since the beginning of the ground-breaking “Nurses’ Health Study” in 1976, clarifying data, and the need for further research in women’s heart health issues, have begun ever so slightly to change things. A massive study now underway, the Women’s Health Initiative, hopes to refine understanding of issues particularly affecting women when it comes to staying heart-healthy. But in actual medical practice, treatment of women with chest pain continues to garner less aggressive treatment than that offered to men.

For example, although heart attack kills more American women than any other cause, for too long only men have been the subjects of studies involving coronary disease and heart health. As recently as three years ago, a Canadian study found that health care professionals do not seem to providing even low cost preventative coronary care for women.

The study of 677 Canadians found that

1—Women were less likely to take aspirin as a heart disease preventative.

2--Even though women were more likely to report chest pain, they were less likely to receive standard cardiac diagnostic tests, including treadmill testing or angiography.

A study of 2400 Israeli women also showed that low dose aspirin therapy reduces the risk of first heart attack in women by about 30 per cent. The March, 1997 issue of the Harvard Heart Letter also notes the existence of compelling evidence that “women with coronary disease

are also likely to benefit from aspirin.”

These results corroborate my personal experiences, and stories I’ve heard so often from other women. Why aren’t women getting proper care for their hearts, and what can be done to change it? Doctors mention the risk of ulcers and excessive bleeding particularly in women taking aspirin, but this is not an excuse to medicate with caution and education.

Women themselves must get involved, particularly post-menopausal women and those with a family history of coronary artery disease. What else can women do to minimize their vulnerability to CAD?

Quit smoking. Women who smoke, the Harvard Heart Letter asserts, are four times more likely to have a heart attack. Quitting removes one-third of this risk within two years, and the risk continues to drop dramatically over the next few years. The risk for stroke decreases, too.

Consider with your physician postmenopausal hormones. While further studies are being done, current data shows that women who take estrogen are half as likely to suffer heart attacks or die from heart disease.

Obesity. Women who gain weight after 18 increase their risk of heart disease through obesity. The risk factor is about equal to that for smoking.

Alcohol use. Light-to-moderate alcohol ntake is associated with a reduced risk of coronary artery disease and of death from all causes, particularly true for women aged 50 and over and for women who have additional risk factors, such as high cholesterol and obesity.

Vitamin E. appears to protect women from CAD, particularly those taking 100 units or more a day.

Aspirin. Women who take one to six aspirins per week have a 32% risk reduction of heart disease

Trans-fatty Acids, found in margarines and vegetable shortenings, fried foods such as french fries and doughnuts, increase the risk of CAD. Women who eat four or more teaspoons of margarine a day have a 66% higher risk of heart disease than those who eat margarine once a month or less.

Cholesterol. Ideal cholesterol levels are changing constantly as more data is gleaned from ongoing studies, but it is generally agreed that women who have had first heart attacks, or who have several risk factors going against them, should try to achieve an ideal LDL cholesterol level of 100 or less.

Exercise. Exercise and diet changes can greatly decrease the possibility of heart disease in women AND men. Local chapters of the American Heart Association (AHA) or the American Dietetic Association can help concerned individuals design plans for lowering their risk for heart disease.

Says Charlotte Libov, M.D., advocate for women’s heart health, for most of this century, two myths concerning woman and heart disease were promulgated.

First, medical school students were taught that women were largely "immune" to heart disease. Second, if a woman did suffer a heart attack, she must be elderly, for certainly heart disease did not afflict young women.

Both are false. To begin with, heart disease is the biggest killer of American women, with over 240,000 dying annually. In addition, even though heart disease generally afflicts older women, about 21,000 women die from it before the age of 65. With a negative heart history in the family, and particularly if high blood pressure is present, women need to take proactive steps at once to minimize their risk of serious coronary consequences. Their heart health has been minimized by the medical community for far too long.