You know all about the pink ribbon and its derivatives. Each October, for National Breast Cancer Awareness Month, the effort to raise awareness, funds, and hope around a once-taboo topic has worked, with pink-cleated NFL players and a pink-lit White House all joining the cause. And for good reason: About 1 in 8 women will be diagnosed with invasive breast cancer, and 1 in 36 will die from the disease, according to the American Cancer Society.
You may, however, be less familiar with the red dress, and its arresting message: Heart disease is the No. 1 killer of women. In fact, more women die from heart disease than from all cancers combined, according to the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association.
[See Tips for Heart Health.]
And yet, this threat often goes unrecognized. Hence, the red dress icon, created in 2002 by the NHLBI as the emblem of its public education campaign, "The Heart Truth." "When women hear the term 'heart disease,' they may still think it's a 'man's disease,'" says Nakela Cook, a cardiologist and chief of staff to the NHLBI director.
In the last decade, heart attack deaths in women have dropped steadily, "so a lot of the things that we've been doing are beginning to show benefits," says Nieca Goldberg, medical director of The Joan H. Tisch Center for Women's Health, NYU, Langone Medical Center and a national spokesperson for the American Heart Association's "Go Red for Women" campaign.
Still, plenty of misperceptions abound. Nearly half of women don't grasp the extent of this threat, and African-American and Hispanic women, who are disproportionately affected by heart disease, are even less informed, Cook says.
And yet, as the leading cause of death for both men and women, heart disease requires everyone's attention and prevention, says Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic in Rochester, Minn. "There's choices that each and every one of us can make each day that will make a difference in our heart health," she says.
Below, some of the critical myths and facts about women's heart health and heart health in general:
MYTH: I've got low cholesterol. That lets me bypass the whole bypass business.
Heart disease is what's called a "multi-risk factor disease," Goldberg says. It can result from a range of reasons: family history, smoking, high blood pressure, diabetes, being overweight or obese, and a sedentary lifestyle, Goldberg says.
That's why experts urge everyone to know their risk factors—regularly checking their cholesterol and blood pressure levels, for example—and respond accordingly. As Cook explains: "Some women believe that doing just one healthy thing is enough to make them not at risk. For example, they may think that if they walk or swim regularly, they can still smoke and that the exercise will counter the smoking risk factor. That's faulty reasoning. To protect your heart, it is vital to make changes that address each risk factor you have."
MYTH: If heart disease is genetic, then I'm doomed.
No, no, and no. Even with family history of heart disease, studies have found that lifestyle changes lower one's heart-attack risk, says Goldberg. "A lot of the ways to prevent heart disease are things that we all have to do ourselves." That means at least a half-hour of aerobic exercise every day—and if that seems daunting, she advises working up to it or employing 10-minute intervals.
Goldberg also suggests following a Mediterranean diet: Have at least five daily servings of colorful, antioxidant-rich fruits and vegetables, swap saturated and trans fats for monounsaturated fat, and get your omega-3 fatty acids from fish.
[See Plant-Based Diets: A Primer.]
For her part, Cook proposes the DASH diet, a government-created program to reduce high blood pressure. Focus on fruits, vegetables, whole grains, fish, nuts, and poultry, she says, and keep salt, sugar, red meat, and calories in check. Also, "move every day," she says, and suggests brisk walking, dancing, and gardening.
Unlike telling people to ditch the cheesecake or prime rib, exercise is "one behavior that actually makes you feel better," Hayes says. She also advises getting seven to eight hours of sleep each night.
MYTH: My chest pain was on the right side, not the left, so I couldn't be having a heart attack.
"That's a total myth," Goldberg says. The pressure or tightness associated with heart disease can show up anywhere in the chest, even the upper abdomen, and commonly spreads to the arm, neck, and jaw, she says. But unlike men, for whom chest pain is the most common symptom of heart attack, only half of female heart attack patients report chest pain, Cook says. Women more often have back or neck pain, indigestion, heartburn, nausea, extreme fatigue, or trouble breathing, she says. Women are also prone to specific, less-understood conditions such as coronary microvascular disease, which affects the walls of the heart's arteries, and "broken heart syndrome," in which severe emotional stress causes heart muscle failure.
Also, women are more likely to delay reporting heart attack symptoms and less likely to receive the same quality of care shown to men, Cook says, citing lower rates of treatment and more bleeding complications among female cardiac patients.
Similar challenges affect women suffering from stroke. According to a recent Mayo Clinic survey of 209 stroke patients, only 27 percent of the females could name more than two of the six basic symptoms for stroke. The study also showed that married men called an ambulance within 28 minutes of experiencing symptoms, while married women waited 67 minutes, on average. (The disparity among singles was negligible).
Here, too, women experience unique symptoms that may affect their diagnosis, says Eva Rzucidlo, associate professor of vascular surgery at Dartmouth University's Geisel School of Medicine. Classic stroke symptoms include numbness or weakness in the face or arm, a loss of speech or hearing, dizziness, and headache. But women's symptoms can include trouble breathing or even the hiccups, Rzucidlo says. At stake is the extent of recovery, since stroke patients only have a few hours for powerful clot-destroying medicine to take effect.
"We have to be our own advocates, especially if you have risk factors," Rzucidlo says. "The most important thing is for you to understand your disease ... It means talking to your doctor and understanding what your risk factors are and how you can modify those risk factors to make yourself as healthy as possible."
Corrected on 2/19/2013: A previous version of this story misstated Nieca Goldberg's title. She is the medical director of The Joan H. Tisch Center for Women's Health at NYU's Langone Medical Center.