A Change of Heart
A new tool alerts women to their hidden risks of heart disease
Heart trouble is often the furthest thing from a woman's mind, even when she can't breathe and her chest hurts like mad. Back in 2002, for example, Carmella Doppelheuer drove to McDonald's for a Big Mac and supersize fries while gripped by awful chest pain. "It just never occurred to me that it was my heart," says the 56-year-old from Carney, Md. She thought it might be a hernia. "God, I even smoked a cigarette on the way to the hospital later that night, can you believe it?" Admitted to the hospital for observation, she had a full-blown heart attack two days later. Leslie Power, 47, of Jamaica Plain, Mass., ignored her chest pain and shortness of breath for several days in 2005 because she thought she was getting asthma. Then she almost passed out driving to work and ended up in a hospital where doctors labored to prop open one of her blocked arteries with a stent. "Women just don't think about their risk of heart trouble," Power says. "Even me, and I'm an administrative assistant to a cardiologist!"
Though groups like the American Heart Association have been campaigning for years to get women to realize they are indeed at risk, Paul Ridker and his colleagues hope they've hit on a more concrete solution. Last week they unveiled a new tool called the Reynolds Risk Score, a seven-item calculator incorporating new risk factors designed to give women and their doctors the most accurate view ever of their heart risk (box, Page 64). If they are heading for trouble, it also tells women how much actions such as quitting smoking will reduce their chances of ending up like Doppelheuer and Power.
Intervene. It seems to do a good job of picking such women out of the pack. When tested on a large population, the Reynolds score took about half of all women marked as at "intermediate risk" by traditional means-a group with between a 5 and 10 percent chance of developing heart problems during the next decade, which doctors have been unsure whether to treat-and reclassified them at higher or lower risk. "This gives us a chance to intervene with lifesaving medications if we need to," says Ridker, a cardiologist and director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston. "Heart disease is different in women. Yet most of the tools for measuring risk have been developed using men" and so have not worked well for women.
The current dominant tool for estimating risk was developed by the Framingham Heart Study, a federal research project that has studied residents of a Massachusetts town for more than 50 years. But it focused mainly on identifying the factors that led to heart attacks. Those turned out to be things like high cholesterol and blood pressure and a history of smoking. But the emphasis on heart attacks, some critics say, makes it a less accurate predictor for women. Unlike men, who typically first learn they have a problem when their heart seizes up in an attack, women's first sign of heart-related trouble is just as likely to be a stroke, or chest pain caused by blocked arteries that stops short of a major attack. Factors that only forecast heart attacks may not capture the risk of these other problems.
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