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Return to Women Still Largely Unaware That Heart Disease Is Their Leading Cause of Death Overview

More on Women Still Largely Unaware That Heart Disease Is Their Leading Cause of Death

Women Still Largely Unaware That Heart Disease Is Their Leading Cause of Death

NewYork-Presbyterian Doctors Work to Increase Awareness

New York (Sep 22, 2010)

three senior women laugh at an outdoor table

While awareness of cardiovascular disease (CVD) as a leading cause of death among women has increased significantly since 1997, nearly 50% of women still do not correctly know that heart disease/heart attack is their leading cause of death, according to a study from researchers at NewYork-Presbyterian. Alarmingly, only half of the women said that they would call 9-1-1 if they thought they were having symptoms of a heart attack, the researchers reported in an issue of Cardiovascular Quality and Outcomes (vol 3; no 2: p120-127).

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"We have made great progress in raising women's awareness of CVD, but it is still sub-optimal that nearly half of women don't know that CVD is a leading killer," said lead author of the study Lori Mosca, M.D., M.P.H., Ph.D., Director of Preventive Cardiology at NewYork-Presbyterian/Columbia University Medical Center. "This is a barrier to women's health because we demonstrated in our prior research that women who are aware that CVD is their leading killer are more likely to take preventive action," she said.

Lori Mosca, M.D., M.P.H., Ph.D.
Lori Mosca, M.D., M.P.H.,
Ph.D.

The proportion of women who were aware that CVD is the leading cause of death among women was significantly higher in 2009 than in 1997 (54% versus 30%) but was not different from 2006 (57%). Rates of awareness approximately doubled among Caucasian (33% to 60%) and Hispanic women (20% to 44%) and tripled among African-American women (15% to 43%) between 1997 and 2009.

"I was encouraged yet discouraged at the same time when I looked at the racial and ethnic minority data because, while the rate of awareness has gone up tremendously among African-American and Hispanic women, the rate is still significantly lower than that of Caucasians," Dr. Mosca said. "We still have a marked disparity in awareness among minority women, which is really important because they carry a disproportionate amount of CVD risk," she said. African American women are significantly more likely to die of CVD than Caucasian women and Hispanic women have higher rates of CVD risk factors such as diabetes, she explained.

When the participants were asked what they would do if they thought they were having signs of a heart attack, only 53% said that they would call 9-1-1. Women may be uncertain if they are having a heart attack, don't want to bother anyone, and are embarrassed to call emergency services, Dr. Mosca said. This delay in calling 9-1-1 has serious repercussions as it delays the chances for women to receive lifesaving therapies, she added.

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Part of the problem is that 45% of women with heart attacks don't experience chest pain, said Holly S. Andersen, M.D., the Director of Education and Outreach at the Ronald O. Perelman Heart Institute at NewYork-Presbyterian/Weill Cornell Medical Center. Many women don't know that they may present with symptoms of a heart attack that are different than the chest pain that men having heart attacks typically experience. These symptoms in women can include nausea, indigestion, sweating, shortness of breath, fatigue, or jaw pain.

Holly S. Andersen, M.D.
Holly S. Andersen, M.D.

The majority of women in the study cited unproven methods for prevention of CVD including use of multivitamins, antioxidants, and special vitamins (e.g., vitamin C). Dr. Mosca is concerned about this finding for two reasons: 1) if women think they are being protected by another means they may be less likely to engage in healthy lifestyle habits and therapies that have been proven to prevent CVD and 2) these unproven therapies may be costly and/or have negative side effects.

The most common barriers to CVD prevention were family/caretaking responsibilities (51%) and confusion in the media about preventive action (42%), while strategies that the women thought would improve prevention include access to healthy foods (91%), public recreation facilities (80%), and nutritional information in restaurants (79%).

The findings are based on responses from 1142 women aged 25 and older surveyed in 2009. The data were compared with similar surveys conducted between 1997 and 2006.

Working to Increase Awareness

"At The Ronald O. Perelman Heart Institute, we are doing research and trying to improve our care every step of the way with respect to gender," Dr. Andersen said. "The Institute is actively involved in increasing awareness that heart disease is the number one killer of women and in screening for heart disease," she noted. "The screenings are really important because we get people who come to us who are afraid to go to their doctor and who tell us really important things about their health. We get people motivated to make a difference in their health, we educate them, and we empower them."

The Institute has a full-time nurse educator on staff to educate patients as well as their family and friends. In addition, the Hospital has programs aimed toward educating staff and community. "We also feel that we have a big obligation and opportunity to raise awareness not just at our Hospital, but also in New York City, nationally, and internationally," Dr. Andersen said.

Dr. Andersen works in the community educating organizations, schools, and corporations about heart disease and risk reduction and has been featured on national television. In addition, she is working with the New York City Department of Health and the Bloomberg administration on projects to enhance the city's heart health. Another strategy used at the Institute to help prevent CVD is educating pediatricians and obstetricians/gynecologists to screen for heart disease and to speak with children and women about risk reduction.

Dr. Andersen is not alone. Dr. Mosca recently participated in an expert panel convened by the United States Department of Health and Human Services to initiate a major national campaign to raise awareness of heart attack symptoms in women and the importance of calling 9-1-1. In addition, the American Heart Association will place increasing emphasis on raising heart disease awareness in women in the next iteration of its national campaign, she said.

Contributing faculty for this article:

Holly S. Andersen, M.D. is the Director of Education and Outreach at the Ronald O. Perelman Heart Institute at NewYork-Presbyterian/Weill Cornell Medical Center and an Associate Professor of Clinical Medicine at Weill Cornell Medical College.

Lori Mosca, M.D., M.P.H., Ph.D. is the Director of Preventive Cardiology at NewYork-Presbyterian/Columbia University Medical Center and a Professor of Medicine at Columbia University College of Physicians and Surgeons.

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