Gina Simpson was used to living with night sweats and insomnia. She had been experiencing these symptoms since first feeling the effects of menopause three years ago at the age of 47. When her symptoms recently became more acute and were accompanied by chest pain, she began to pay closer attention, but it didn't occur to her that they might be signs of serious heart trouble.
In early February, she decided it was time to alert her primary care physician. Within a period of just four days, her need for dosages of prescribed nitroglycerin spray, a compound used to treat angina (chest pain), jumped from one per day to three per day.
"I was really scared," Simpson said. "I felt like I might be dying. I knew I needed to find out what was going on and fix it right away."
Her primary care physician referred her to Victoria Shin, M.D., interventional cardiologist at Torrance Memorial Medical Center. Shin performed an angiogram on Simpson the next day at
Torrance Memorial's Lundquist Cardiovascular Institute. An
angiogram is a procedure in which a thin tube called a catheter is placed into a blood vessel or artery. Dye is injected into the vessel to make the area clearly visible while a camera takes X-ray pictures. The procedure revealed that Simpson's right coronary artery was 90 percent blocked. A tube known as a coronary stent was placed in the artery to open the blockage. Without treatment, Simpson could have suffered a massive heart attack at any time.
According to Shin, the inability to recognize such potentially serious symptoms is fairly common among women in Simpson's age bracket. It's been known for some time that premenopausal women are protected from heart disease by the hormones estrogen and progesterone. For this reason, in the past, larger efforts were made to increase public awareness for other diseases such as breast cancer, which strike a more definitive chord in a woman's self identity. In truth, women need to start tuning in to their number one killer. More women die from heart disease than the next four causes of death combined, including all cancers.
"For women, breast cancer has a more dramatic presentation. It can mean chemotherapy, hair loss and body altering surgery," Shin said. "With heart disease, the accompanying symptoms-hypertension, diabetes, high cholesterol-are often less dramatic. It can often have no obvious physical manifestations until it's too late."
The symptoms themselves can also be different for women. For example, a man may have acute chest pains while walking up a flight of stairs, but a woman may simply experience fatigue or an inability to do the same activities she previously could do. "Women also tend to be less straight forward about explaining their symptoms or may discount them to their doctor. It's important for the medical community to be aware of these differences," she said.
Shin continued, "Traditionally, as caregivers women nurture everyone else and often put themselves on the backburner. They should not blow off subtle warning signs."
Simpson, who had been caring for her 76-year-old mother, a cancer survivor, for the past year could identify with this role. Despite awareness of high blood pressure and cholesterol in her family history, she struggled to lose an extra 30 to 40 pounds she knew put her at higher risk.
"The last year has been very stressful," Simpson said. "I've just not been able to focus on my own health as much as I should."
When women approach menopausal years in their 40s and 50s estrogen levels decrease. This leaves their hearts less protected and as prone to heart disease as their male counterparts. By age 60 to 65, men and women have approximately equal risk. Some recent data suggests that women above the age of 75 might be at even higher risk than men of the same age.
Studies in the last 10 years have brought to light another condition more prevalent in women than men, coronary microvascular disease (MVD), in which the heart's smallest branches of arteries become dysfunctional. The condition is different than traditional coronary heart disease (CHD), which is caused by a fatty substance called plaque building up in the large coronary arteries. This buildup can lead to blockages that reduce or halt the flow of oxygen-rich blood to the heart muscle. With MVD, plaque doesn't create blockages in these vessels as it does in CHD.
According to Shin, coronary MVD can be more difficult to identify than CHD and is usually considered through a process of excluding other conditions during diagnosis. More advanced diagnostic breakthroughs are in experimental phases. In the meantime, aggressive prevention and treatment of precursors such as high cholesterol and blood pressure are being pursued more than ever and at a younger age.
"Before menopause, women's hormones have a protective effect on their hearts. Good lifestyle choices early on help when hormones diminish," Shin said. In the absence of a family history of heart disease, Shin recommends blood pressure and cholesterol monitoring through a primary care physician starting at the age of 35. With early history among immediate relatives (parents, siblings), she recommends starting in the early 30s.
During her diagnosis and treatment, Simpson learned that her cholesterol and blood pressure were higher than optimal and that stronger medications were needed to stabilize her condition. Now on disability from her job as a client account manager for a company in Culver City, she's able to focus on taking her medication, exercising, eating right and losing weight to get her health back on track. A conversation with her mother in the hospital also revealed a surprise family fact. Her father had also suffered from angina.
"Press to get the answers about your family history," she urged. "Sometimes you have to push harder than may feel comfortable. People don't want to talk about it, but the answers could save your life."