From The Commuting Doc

By Leonard Pianko, MD, FACC

Heart disease and stroke are the first and second leading causes of death in America–30% of all deaths are from cardiovascular illness. Although heart disease is often thought of as affecting men primarily, this is a mistaken assumption. In fact, more women die from heart disease every year than men.

More than 400,000 women die every year in the United States from heart disease, accounting for one out of every four female deaths. However, researchers have found that many women underestimate their risks of heart attack and stroke. Despite efforts to increase awareness, only about half of women recognize cardiovascular illness as the leading cause of death.

Silent Killer

This low health literacy regarding heart health among women translates to suboptimal risk reduction and treatment. Studies have found that women are less likely to be counseled on steps to reduce risk and often receive less medical intervention than their male counterparts. Although nearly 7% of American women have coronary heart disease, most are unaware of the health risks entailed.

An additional challenge facing women with regard to cardiovascular illness is the discrepancy in presentation of symptoms between women and men. While men often exhibit early signs of heart disease, women frequently remain asymptomatic until the disease is very advanced and a cardiovascular incident is either imminent or has already occurred. Almost two-thirds of women who die suddenly from stroke or heart attack have experienced no previous symptoms, making cardiovascular illness a stealthy and silent killer. Furthermore, when women do experience symptoms of heart disease, these may be different than the symptoms generally described by men.

Men And Women:
Different Symptoms

While many men describe chest pain–or angina–as a crushing or squeezing feeling in the chest that radiates down the arm, women may be more likely to describe sharp or burning chest pain that radiates to the neck, jaw, and back. Women may also experience varied physical symptoms apart from chest pain, such as abdominal discomfort, nausea and vomiting, profuse sweating, dizziness, and fatigue.

Because of the wide variation in symptoms and the discrepancy from typical crushing chest pain, women are less likely to seek medical attention and be diagnosed with cardiovascular illness.

Another difference in presentation of symptoms between men and women is when episodes occur. Frequently men who experience angina find that pain intensifies with physical activity and subsides while resting.

Women, on the other hand, are more likely to have pain while resting or even sleeping. Angina in women will also be triggered during routine daily activities as well as during times of mental or emotional stress rather than during intense physical exercise.

These two major differences between how women and men present exacerbates the under-diagnosis and treatment of women with cardiovascular illness, which may in turn increase the risks of cardiovascular events such as heart attack and stroke. If heart disease is not diagnosed until the patient suffers a serious medical crisis, rehabilitation may be more difficult. At our cardiology clinic, we strive to prevent such events through early diagnosis and prevention.

The Risk Factors

Because of the relative silence of heart disease in the case of female patients, this intervention is only possible if we can monitor risk factors and implement risk reduction even without the presentation of symptoms. These risks also increase dramatically after menopause, making it especially critical for older women to closely monitor heart health.

Lifestyle Choices

To reduce the risks of heart disease, there are a number of lifestyle choices that can make a significant difference. These include:

Quit smoking. Women who smoke are 25% more likely to develop heart disease and suffer smoking-related complications than men who smoke. Smoking also doubles women’s risk of sudden cardiac death, making smoking cessation a top priority.

Choose a healthy diet. Reduce intake of fatty meat, especially after menopause, and increase intake of fruits, vegetables, fiber-rich whole grains, and low-fat protein. High-protein diets and yo-yo dieting in older women has been linked to increased risk of cardiovascular illness. It is important to consult with your physician prior to beginning any diet.

Exercise regularly. Just 150 minutes of activity per week can reduce risks of heart disease.

Limit alcohol. A maximum of one drink per day is recommended.

Lower stress. Stress at work has been linked to a 40% increase in heart-health risk and has also been linked to obesity. Finding healthy ways to reduce stress can positively impact a woman’s overall health.

What Can Your Doctor Do?

While lifestyle changes are important, it is also necessary for women to undergo regular checkups to monitor heart health. Some things that your doctor will do to ensure that you are maintaining optimal cardiovascular health include:

Monitoring blood pressure. High blood pressure contributes to heart disease and increases the risk of adverse events, yet is often asymptomatic.

Testing for diabetes. Uncontrolled diabetes significantly raises the risks of cardiovascular illness. While diabetes can be controlled, it is important to diagnose it and implement an appropriate management plan.

Monitoring triglycerides and cholesterol. High triglycerides combined with high levels of “bad” LDL cholesterol and low levels of “good” HDL cholesterol speed up the buildup of plaque along arterial walls, which in turn increases the risk of heart attack and stroke. These levels can only be determined through regular blood tests.

At our cardiology practice in Aventura, Florida, we strive to implement early intervention to reduce the risks of cardiovascular illness. We are here to guide and support all of our patients, and our staff is uniquely equipped to treat each patient according to their individual health needs and goals. If you would like to make an appointment, please contact us at 305-384-4720 or check us out at At Dr. Pianko’s medical practice, we offer cardiovascular care with heart. v

Leonard Pianko, MD, FACC, the founder of the Aventura Cardiovascular Center, is board certified in cardiology and internal medicine, with special expertise in cardiovascular disease, preventive cardiology, and non-invasive treatment options, including echocardiogram and nuclear stress testing.

Dr. Pianko was born in the Bronx and earned an undergraduate degree from Yeshiva University before receiving his medical education at Mount Sinai School of Medicine and completing his training at the prestigious Robert Wood Johnson School of Medicine in New Brunswick, NJ. For more information, contact Dr. Pianko at



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