Expert Q & A:
The Leading Killer of Middle-Aged Women?
It’s not breast cancer. Cardiologist Joana Magno sheds light on a little-recognized phenomenon.
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Dr. Joana Magno campaigns to raise awareness of women’s risk of heart disease and volunteers for the American Heart Association’s Hawaii affiliate. She is a physician champion of the Women’s Heart Advantage Program at The Queen’s Medical Center, where she is also chief of cardiology. She teaches as an assistant clinical professor at the University of Hawaii John A. Burns School of Medicine and practices medicine in Honolulu and on Molokai.
Dr. Magno: Yes. Traditionally we’ve been taught that women have female hormones, we’ve been protected against heart disease and that we don’t really have to worry about coronary disease until our hormone levels change to the equivalency of post-menopausal.
But in reality, in this age group, heart disease is the number one killer. It’s not breast cancer.
Dr. Magno: If you’re a smoker, you’re at risk. If you’re a woman who has diabetes, that’s a significant risk. In fact, someone who has diabetes, even if they’ve never had a heart attack before, is considered in the same category of risk as someone who’s already had a heart attack.
And family history. I really like it when people come in early. I don’t like it when they come in and tell me, I’m 52, and my dad had a heart attack when he was 53.
It’s much better to know your family history and make sure you’re doing everything you can to protect yourself from developing heart disease. Knowing what your blood pressure is, knowing what your cholesterol values are, knowing when it would be appropriate to go on medication, all those things are important.
So get rid of bad habits like cigarette smoking or not exercising regularly or not eating properly. They’re very simple things, but like I tell people, I can’t put those things in a pill.
Dr. Magno: There is an interesting stress component to heart disease. Something we’ve seen a lot more of is a special kind of a heart attack where patients can develop sudden heart symptoms associated with a stressful event, sort of like broken heart syndrome (severe but reversible heart muscle weakness that mimics a classic heart attack). And that’s more common in women. It may not be associated with artery blockage per se.
But it’s hard to quantify stress, you know? You can say, “Oh I’m stressed,” but people respond to stress in different ways. And there’s no good way to measure how stressed you are.
So stress is important, but stress alone isn’t going to make you have a heart attack. We all live with stress of varying severity every day; you can’t avoid stress in your life. But making sure people have ways to deal with stress in positive ways is important for your heart. If you deal with stress by drinking or smoking, that’s not good. If you defuse stress with things like exercise and meditation, those sorts of things probably make more sense.
Dr. Magno: The red dress is the symbol of heart disease for women. The American Heart Association started this campaign because women were not being recognized as having heart attacks—this has been underrecognized and undertreated.
When I went to medical school a few years back, most cardiologists were men, and most heart patients were men. In those days, we thought the only women who developed coronary disease or heart attacks were women with diabetes. But now you’ll see that there are many, many women coming into catheter labs like ours who have coronary disease, who end up with angioplasty or bypass surgery. And who, because of these interventions, live longer.
I see some of the saleswomen at Nordstrom’s and Macy’s with their little red heart pins and I go up to them and say, “You know what that stands for?” And they tell me, “Yes!” Women have heart disease, women can have heart attacks. Once in a while someone tells me they don’t know what it stands for, and I tell them.
We need women to know how they can prevent getting heart disease or if they have symptoms, to recognize them. So every February we celebrate Heart Month.
Dr. Magno: Heart attacks in women can have typical symptoms. I try to stress that it’s important to know what the typical symptoms are. Go to the americanheart.org website and see. Common symptoms include pain or discomfort in the chest, arms, neck, back, jaw or stomach. Women can also experience shortness of breath, nausea or vomiting.
There’s no one single symptom that absolutely signals a heart attack. But most of the chest discomfort is going to be in the middle of the chest. Everybody thinks the heart is on the left side, the pain should be on the left side: It may not be. The classic symptom is a dull, squeezing pain underneath the breastbone.
It’s important for women to recognize the typical symptoms, but occasionally they could have symptoms that are less typical, like just fatigue or breathlessness, without the chest pain. With fatigue, when you’re doing something exertional, you may just feel an inability to do anything.
Women with diabetes also don’t necessarily have typical symptoms.
If there is a concerning symptom, the important thing is not to ignore it. It’s important to bring it to a doctor’s attention or call 911 if necessary.
Dr. Magno: Most people don’t realize how small the arteries are that feed the heart muscle. For most of us, the diameter of the main blood vessel that goes into the heart is probably around 3 or 3.5 millimeters. It’s not that big, you know? It’s not like your garden hose. It’s not like plumbing in your house.
They’re very small blood vessels, so it doesn’t take a lot of crud to jam those things up. And once you have heart disease, you can’t buy a pill that’ll make it go away.
AL: Is it true that among women who are 40 to 54 years old, heart disease is the number one killer?
Dr. Magno: Yes. Traditionally we’ve been taught that women have female hormones, we’ve been protected against heart disease and that we don’t really have to worry about coronary disease until our hormone levels change to the equivalency of post-menopausal.
But in reality, in this age group, heart disease is the number one killer. It’s not breast cancer.
AL: What are the main risk factors?
Dr. Magno: If you’re a smoker, you’re at risk. If you’re a woman who has diabetes, that’s a significant risk. In fact, someone who has diabetes, even if they’ve never had a heart attack before, is considered in the same category of risk as someone who’s already had a heart attack.
And family history. I really like it when people come in early. I don’t like it when they come in and tell me, I’m 52, and my dad had a heart attack when he was 53.
It’s much better to know your family history and make sure you’re doing everything you can to protect yourself from developing heart disease. Knowing what your blood pressure is, knowing what your cholesterol values are, knowing when it would be appropriate to go on medication, all those things are important.
So get rid of bad habits like cigarette smoking or not exercising regularly or not eating properly. They’re very simple things, but like I tell people, I can’t put those things in a pill.
AL: Is there a link between middle-aged women having heart attacks and stress at this point in their lives?
Dr. Magno: There is an interesting stress component to heart disease. Something we’ve seen a lot more of is a special kind of a heart attack where patients can develop sudden heart symptoms associated with a stressful event, sort of like broken heart syndrome (severe but reversible heart muscle weakness that mimics a classic heart attack). And that’s more common in women. It may not be associated with artery blockage per se.
But it’s hard to quantify stress, you know? You can say, “Oh I’m stressed,” but people respond to stress in different ways. And there’s no good way to measure how stressed you are.
So stress is important, but stress alone isn’t going to make you have a heart attack. We all live with stress of varying severity every day; you can’t avoid stress in your life. But making sure people have ways to deal with stress in positive ways is important for your heart. If you deal with stress by drinking or smoking, that’s not good. If you defuse stress with things like exercise and meditation, those sorts of things probably make more sense.
AL: You’ve been very active in spreading the message about women and heart health. Tell us about that little red dress pin you’re wearing.
Dr. Magno: The red dress is the symbol of heart disease for women. The American Heart Association started this campaign because women were not being recognized as having heart attacks—this has been underrecognized and undertreated.
When I went to medical school a few years back, most cardiologists were men, and most heart patients were men. In those days, we thought the only women who developed coronary disease or heart attacks were women with diabetes. But now you’ll see that there are many, many women coming into catheter labs like ours who have coronary disease, who end up with angioplasty or bypass surgery. And who, because of these interventions, live longer.
I see some of the saleswomen at Nordstrom’s and Macy’s with their little red heart pins and I go up to them and say, “You know what that stands for?” And they tell me, “Yes!” Women have heart disease, women can have heart attacks. Once in a while someone tells me they don’t know what it stands for, and I tell them.
We need women to know how they can prevent getting heart disease or if they have symptoms, to recognize them. So every February we celebrate Heart Month.
AL: That’s a good point. Is it true that heart attack symptoms for women can be different from men’s symptoms?
Dr. Magno: Heart attacks in women can have typical symptoms. I try to stress that it’s important to know what the typical symptoms are. Go to the americanheart.org website and see. Common symptoms include pain or discomfort in the chest, arms, neck, back, jaw or stomach. Women can also experience shortness of breath, nausea or vomiting.
There’s no one single symptom that absolutely signals a heart attack. But most of the chest discomfort is going to be in the middle of the chest. Everybody thinks the heart is on the left side, the pain should be on the left side: It may not be. The classic symptom is a dull, squeezing pain underneath the breastbone.
It’s important for women to recognize the typical symptoms, but occasionally they could have symptoms that are less typical, like just fatigue or breathlessness, without the chest pain. With fatigue, when you’re doing something exertional, you may just feel an inability to do anything.
Women with diabetes also don’t necessarily have typical symptoms.
If there is a concerning symptom, the important thing is not to ignore it. It’s important to bring it to a doctor’s attention or call 911 if necessary.
AL: Any thoughts you want to leave us with?
Dr. Magno: Most people don’t realize how small the arteries are that feed the heart muscle. For most of us, the diameter of the main blood vessel that goes into the heart is probably around 3 or 3.5 millimeters. It’s not that big, you know? It’s not like your garden hose. It’s not like plumbing in your house.
They’re very small blood vessels, so it doesn’t take a lot of crud to jam those things up. And once you have heart disease, you can’t buy a pill that’ll make it go away.
