Does your primary care doctor have outdated notions about women and stress that could obstruct diagnosis of heart disease? Here are 3 false statements to watch out for.
Heart disease is the leading cause of death among women; in fact, more women than men die of the disease each year. Astonishingly, though, primary care doctors often fail to heed all the warning signs when diagnosing female patients, according to two recent studies — and long-entrenched gender bias appears to be responsible for the failure.
In the studies, 230 doctors were shown the medical reports of a fictional 47-year-old man and a 56-year-old woman. When the patients' symptoms were listed as chest pain, shortness of breath, and irregular heartbeat, the majority of physicians arrived at the same diagnosis for both. However, when "stress" was added to the complaints, only 15% of the doctors diagnosed heart disease in the woman, while more than half of them identified it in the man. Sixty-two percent of the physicians referred the male patient to a cardiologist, while less than half as many referred the female. Only 13% of the doctors prescribed medication for the woman; 47% wrote a script for the man.
Here are some potentially erroneous statements you may hear from your doctor — and the straight facts that belie them:
"Your shortness of breath is just anxiety."
If you're having trouble taking deep breaths — almost like you're hyperventilating — anxiety probably is the cause. But if you're having difficulty catching your breath — you're panting — then it's more likely a heart or lung problem (though it may be poor conditioning). This is another reason to exercise regularly; any shortness of breath or chest discomfort during an activity that's normally comfortable is often a sign of trouble.
"Don't worry, your HDL (good cholesterol) is terrific."
Women generally have higher HDLs than men. But one study found that 20% of women who suffered heart attacks had HDLs over 60 — a level thought to be protective. If you're postmenopausal and have high or even borderline cholesterol levels or other risk factors, request a CT heart scan with calcium scoring, the best test for detecting plaque in your coronary arteries and predicting a future heart attack.
"You're fine because your major arteries are clear."
Symptoms of cardiac disease are generally linked to plaque buildup in the big coronary arteries on the heart's surface. Women, however, can also develop problems in the small interior vessels. This is called "microvascular disease," and symptoms can be vague (shortness of breath, flulike feelings, anxiety, fatigue). Conventional angiograms and CT scans won't detect it, so if you're suffering from that constellation of symptoms, get a nuclear stress test. If it shows areas of the heart deprived of blood during exercise, microvascular disease may exist.
As doctors learn more about how heart disease affects men and women differently, I'm sure some of these old biases will disappear. That's one statement you can count on.
Arthur Agatston, MD, an associate professor of medicine at the University of Miami Miller School of Medicine, is the author of The South Beach Diet Supercharged: Faster Weight Loss and Better Health for Life. He maintains a cardiology practice and research foundation in Miami Beach, FL.