National Wear Red Day Raises Awareness For Cardiovascular Disease In Women

Heart disease is typically thought of as a male disease, but it's also the leading cause of death for women, killing nearly 420,000 women in the U.S. each year. Understanding the risk can help women take steps to protect their health.

The most common sign or symptom of heart disease is chest pain — but that's not always the case for women, explains CBS News medical contributor Dr. Tara Narula, who is a cardiologist. 

"What we tell women is that they may not have the type of chest pain that you see in the movies, where you're falling over and clutching your chest," Narula told CBSN.

Much more "subtle" symptoms can also be an indicator of heart disease, she said. Some people will only experience a "faint sensation of pressure" or pain in the jaw, back, or arm, while others will only experience shortness of breath, fatigue, dizziness, and even flu-like symptoms. 

According to Narula, female patients should be especially attuned to these potential symptoms. Many women will attribute them to the gastrointestinal tract, acid reflux, stress or anxiety, before they ever consider the heart. 

"I always tell women, any new chest pain that you experience needs to be evaluated," she said. "You always want to make sure it's not the heart first, before you blame another system."

Heart disease claims more lives every year than all forms of cancer combined, according to the American Heart Association. Some people are at a higher risk for heart disease through factors that are out of their control, such as age and family history. But Narula explained that about 80% of total cases are brought on by lifestyle choices, and therefore can be prevented. 

According to Narula, traditional risk factors include high cholesterol, diabetes, high blood pressure, smoking, alcohol use, stress, weight, and lack of sleep or exercise. For women, however, the medical community is learning that there are several additional risk factors unique to both female biology and gendered stereotypes. 

Lupus, rheumatoid arthritis, PCOS (polycystic ovarian syndrome), and complications during pregnancy, such as gestational hypertension, preeclampsia, and eclampsia, are all "nontraditional risk factors" that can put a woman at greater risk for heart disease, according to Narula. 

Heart disease is the leading cause of maternal deaths, but the distinctions between men's and women's risk for heart disease has only recently been seriously discussed in the medical community. Narula said this is in part because women have long been "under-studied." 

The lack of inclusion of women in medical research is an international issue. According to the American Heart Association, "globally, only about 43% of clinical trial participants are women, with the U.S. faring slightly better at 49%."

"Most of our clinical research has been done on men," Narula said. "And we have learned, thankfully, that women are not just smaller versions of men. Our bodies are different, and we need to be researched, and studied, and treated differently." 

Once women make it to the hospital with possible heart symptoms, however, unequal treatment can lead to even bigger problems. 

"More often than not, if a woman goes to the hospital with chest pain, she may be told she's just anxious, and discharged," Narula said. 

"It's a systemic problem that we're working on both with improving the research and the education of physicians on how to treat women, and also making sure that women understand that they need to be vocal and prioritize their health."

According to Narula, in addition to the need for "sex-specific" research, there also needs to be research that looks at how heart disease affects races differently. For example, African American women — a demographic at risk of unequal and inadequate medical treatment — are three times more likely to die from complications due to hypertension during pregnancy.

Narula said it's important to never downplay your symptoms. "Bring them up with your doctor and let them figure it out," she said.