Tracy Solomon Clark is outgoing and energetic — a former fundraiser for big companies and big causes. As she charged through her 40s she had "no clue," she says, that there might be a problem with her heart.
It was about six years ago — when she was 44 — that she first suffered severe shortness of breath, along with dizziness. She figured she was overweight and overworked, but never considered heart disease.
"That was the furthest thing from my mind," Solomon Clark says. "I was young!"
But it was her heart. Her doctor sent her to the hospital emergency room, where physicians diagnosed a blockage in a key artery. They inserted a stent to open it up and ease blood flow to her heart.
Ultimately Solomon Clark, who lives in Gardena, Calif., received several more stents to treat what turned out to be serious cardiovascular disease. Last year she had double-bypass surgery to replace the left main artery of her heart.
Dr. Noel Bairey Merz, who directs the Barbra Streisand Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles, says she is not surprised by Solomon Clark's experience. Bairey Merz often meets young and middle-aged women who have no idea they are at risk for heart disease and a heart attack.
She and colleagues recently surveyed 1,011 women ages 25 to 60, a random sampling from across the U.S. Only about half of those interviewed knew that heart disease is the leading threat to women's lives, the scientists found. Many thought breast cancer poses a bigger risk. They were wrong.
Every year in the U.S. about 40,000 women die from breast cancer, according to statistics from the Centers for Disease Control and Prevention. Meanwhile, roughly 10 times that number die from heart disease.
Greater awareness and advances in detection and treatment have dramatically decreased breast cancer deaths over the past few decades, Bairey Merz explains. But heart disease now claims the life of 1 in every 4 women.
Many women with heart disease could benefit from effective treatment, including aspirin, statins, beta blockers and the like, says Dr. Laxmi Mehta, a cardiologist at the Ohio State Wexner Medical Center. But they can be helped only if they are diagnosed.
After the stent was placed, Solomon Clark continued to have periodic bouts of dizziness, shortness of breath and even a little pain. The symptoms were eventually traced back to continuing heart trouble.
But not right away. When she returned to an ER to have the symptoms checked out, tests suggested no new blockages, and the emergency room doctors told her she might just be suffering an anxiety attack.
Mehta chaired a committee of the American Heart Association that this year released the organization's first scientific statement on the problem of heart attacks among women.
Even after a heart attack, Mehta says, women are less likely than men to be referred to cardiac rehabilitation programs, though these programs significantly reduce the chances of a second heart attack.
Part of the reason women are misdiagnosed or not diagnosed at all is that heart disease looks a lot different in women than it does in men, she says. And men have been the focus of most heart disease research.
For example, men are more prone to blockages in major arteries — which are relatively easy to spot on an angiogram and are more likely to prompt timely diagnosis, Mehta says.
Women, on the other hand, are more likely to have problems with tiny arteries embedded in the heart, she says. These smaller blood vessels often are not visible on angiograms, and also don't fill up with plaque.
"They don't have enough of a wall to build up plaque," says Bairy Merz. "That's how tiny they are." But these small arteries can lose flexibility and run into problems — constricting too much and cutting off blood flow to the heart.
In her survey, Bairey Merz found that 74 percent of the women had at least one heart disease risk factor, such as high blood pressure, high cholesterol, diabetes, irregular menstrual periods, early menopause or a family history of heart disease. Yet only 16 percent reported having been told by a doctor that they had an elevated risk.
Instead, Bairey Merz says, the doctors, who also were surveyed by the researchers, were more concerned about their patients' weight and breast health than heart disease.
All primary care doctors should routinely assess a woman's risk for heart disease, Mehta says. And if they don't, women should take the lead and bring up the subject of heart disease and their individual risk. (You can start by using this online risk calculator.)
Pay attention to your body, Mehta tells her patients. "If something seems out of the ordinary, it's best to seek medical attention, especially if something is occurring only with exertion — or worsening with exertion.
"I'd rather be wrong and go to the ER," Mehta says, "than die at home."
AILSA CHANG, HOST:
Many people think the number one killer of women is cancer. It's not. It's heart disease. And as NPR's Patti Neighmond reports, only half of all women know this is their biggest health threat.
PATTI NEIGHMOND, BYLINE: Tracy Solomon Clark is outgoing and energetic, a former fundraiser for big companies and big causes. About six years ago, at just 44 years old, she had severe shortness of breath. She was dizzy. She went to the doctor and ended up in the hospital. She had no idea her symptoms had anything to do with heart disease.
TRACY SOLOMON CLARK: Not a clue. Heart? That was the farthest thing from my mind. There was no way it would be my heart. I'm young.
NEIGHMOND: But it was her heart. An angiogram showed a blockage. And a stint was inserted to open the artery. Even so, doctors did not diagnose heart disease. And Solomon Clark's symptoms persisted.
SOLOMON CLARK: It felt like a chest cold. And so they were treating me for a chest cold.
NEIGHMOND: Which clearly didn't help. Solomon Clark still felt out of breath and dizzy. Even when she went to the hospital, ER doctors, again, failed to diagnose heart disease.
SOLOMON CLARK: And they do an EKG and they were like, there's nothing wrong, you know? Or she's having anxiety attack.
NEIGHMOND: An anxiety attack for a woman with a clear history of heart problems. At Cedars-Sinai Medical Center in Los Angeles, cardiologist Noel Bairey Merz often sees situations like this. She directs the Barbra Streisand Women's Heart Center. And she recently surveyed about 1,000 women to find out what they knew about their risk for heart disease.
NOEL BAIREY MERZ: Only about half of women in the United States know that heart disease is the leading health care threat for women. A majority of those that didn't know it still thinks it's breast cancer.
NEIGHMOND: About 40,000 women die every year from breast cancer. Ten times as many die from heart disease. Bairey Merz says many of them could be saved. Once women are diagnosed with heart disease, treatments can be highly effective. But lots of women are misdiagnosed, often for years, in part because heart disease looks a lot different in women than it does in men.
Most research has focused on men who are prone to blockages in major arteries, which are easy to see on an angiogram. Women, on the other hand, are more likely to have problems with teeny tiny arteries embedded in the heart, which can be difficult to see and aren't likely to fill up with plaque. Bairey Merz.
BAIREY MERZ: They don't have enough of a wall to build up plaque. They're that tiny. But what they are is dysfunctional. They can fail to dilate when it's needed. Or they actually constrict.
NEIGHMOND: So if a woman suffers a heart attack and there's no obvious blockage, doctors often don't treat them for heart disease. Cardiologist Laxmi Mehta chaired a committee of the American Heart Association, which, just this year, wrote its first scientific statement on heart disease and women.
LAXMI MEHTA: They are less often prescribed the typical medications we give a heart attack patient such as aspirin, statins, beta blockers.
NEIGHMOND: And even after a heat attack, Mehta says, women are less likely than men to be referred to cardiac rehab programs, which dramatically prevent second heart attacks. When Dr. Bairey Merz surveyed women about heart disease, she also surveyed doctors.
BAIREY MERZ: Top concerns expressed by the physicians for their female patients - number one was weight management, number two was breast health, and number three was cardiovascular health.
NEIGHMOND: And she says it should be the opposite. Number one, heart health; two, breast health and three, weight. Dr. Laxmi Mehta says that with underdiagnosis and undertreatment of women with heart disease, she tries to get across a simple but important message to her female patients.
MEHTA: You need to pay attention to your body. If something seems out of the ordinary, best to seek medical attention, especially if something seems out of the ordinary and is occurring only with exertion or worsening with exertion. I'd rather be wrong and go to the emergency room than die at home is what I would tell my patients.
NEIGHMOND: Mehta says all primary care doctors should assess a woman's risk for heart disease on a routine basis. And if they don't, she says, women should take the lead and bring up the subject of heart disease. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.