At the urging of the nursing community and the public at large, on January 6, 2000, WHF registered a Purple Ribbon as a new service mark to raise awareness about women’s number one killer. This tiny 7-inch piece of ribbon represents another grass-roots effort by WHF to improve survival and quality of life for women with heart disease.

Advocacy for Women's Heart Health

It's easy to show your support of this Awareness & Advocacy Campaign. Just wear a Purple Ribbon during Women’s Heart Week February 1-7– or anytime – to promote women's heart health and gender care awareness (to make an awareness ribbon, cut a 7-inch length piece of purple ribbon and tack onto your lapel using a straight pin).

Another way to show your support is to write to your congressman or senator and ask that he/she support a line-item deduction for heart wellness programs for women. Become an endorsers of the HEART For Women Act. Ask congress to pass this important piece of legislation within the year 2006. The HEART For Women Act represents a turning point in women's heart care – and a new beginning toward the practice of gender–specific, evidence–based medicine. The Women's Heart Foundation urges everyone to voice their support. Contact Congress today!

Facts and Statistics

• Heart disease is the number one cause of death for American women age 35 and older and kills six times as many women as breast cancer. A recent study showed that 90% of primary care physicians still don't realize that heart disease kills more women than men each year.
• Women's heart disease is often misses as interpretation of angiography is based on men's heart disease… results of the WISE (Women's Ischemic Syndrome Evaluation) study. Go to Report on the WISE Study - Jan 31, 2006.
• Nearly twice as many women in the United States die of cardiovascular diseases than from all forms of cancer combined.
• One woman in eight will develop breast cancer over the course of her lifetime, but only one in 25 will die of it. More than 50% of all American women will die from heart disease
• Each year, approximately 250,000 women die suddenly from a heart attack.
• Men are more likely to have heart attacks at an earlier age than women but women have a much poorer outcome once diagnosed with heart disease.
• Nearly two-thirds of the deaths from heart attacks in women occur among those who have no history of chest pain.¹
• Women wait longer than men to go to an emergency room when having a heart attack and physicians are slower to recognize the presence of heart attacks in women because “characteristic” patterns of chest pain and changes on electrocardiograms are less frequently present.²
• After heart attacks, women are less likely than men to receive therapies known to improve survival, contributing to a higher rate of complications after heart attacks in women, even after accounting for higher average age of the women.³
• Physicians are less likely to order tests to evaluate chest pain in women than in men.
• Under age 50, women’s heart attacks are twice as likely as men’s to be fatal.
• Older aged women are twice as likely as men to die within the first few weeks after suffering a heart attack.
• Women are two to three times as likely to die following heart bypass surgery.
• The risk of heart attacks in women with diabetes is more than double that of non- diabetic women.
• Diabetes affects many more women than men after the age of 45.
• In 1990, more than 87,000 women died of stroke, compared to 56,697 men.
• African-American women represent the “tip of the iceberg” for both heart attack and stroke deaths. According to the American Heart Association, the 1995 death rate for cardiovascular disease was 67 percent higher for African-American women than for white women. According to the National Stroke Association, the death rate for stroke is 79.8 percent higher for African-American women than white women.
• High blood pressure (HBP) -- a major risk factor for both heart disease and stroke -- affects two-thirds of the African-American population.
• Cardiovascular disease has killed more women than men every year since 1984.
• The gap between male and female deaths continues to widen each year.

This graph shows the rising death rate of women with heart disease in thousands (Yrs 1979-96) and demonstrates the widening gap between men's and women's survival. Biostatistics from Baltimore Union Memorial Hospital. Used by permission.

Raising Awareness

Many women are not aware of their risks. Consider these lifestyle facts:

• 27% of American women smoke. Smoking ranks as the #1 controllable risk for heart disease. Young women are taking up cigarette smoking in growing numbers.
• 70% of American women don't exercise regularly. Lack of physical activity is a major risk factor for heart disease and contributes to weight gain, obesity and many other illnesses

Unhealthy lifestyle choices place a woman at risk and so does lack of awareness. If a woman does not realize she is at risk, she will not be motivated to making healthy changes, nor will she be able to respond to heart disease symptoms once they occur. This can lead to diagnostic delays with more advanced vessel disease and higher likelihood of death.

It’s equally important for practitioners to be aware of heart disease as a health risk in women. A recent survey indicated that many physicians did not realize that heart disease is women's number one killer! With raised awareness by practitioners and women, more routine screening should occur.

Symptom recognition is another problem. About one-third of women don't have the typical symptoms of severe, crushing chest pain that radiates to neck, shoulder(s), arm(s) or back. Many just report having sudden onset of severe fatigue –– like the flu, with vague chest “discomfort”. These nonspecific symptoms are difficult for a woman to identify as being heart-related. Other symptoms often experienced by a woman include mild burning sensation in the middle of the chest with a transient feeling of panic and dizziness, and severe indigestion with upper abdominal pain, nausea and vomiting. If a woman is not able to recognize symptoms and seek the necessary care early on, it could cost her her life.

Poorer Outcomes

Clinically, women have a worse outcome then men. Women experience...

• Twice the death rate after suffering a heart attack
• Twice as long a wait in the emergency room with chest pain
• Twice the incidence of a second heart attack within the first two weeks
• Two to three times the death rate after coronary bypass surgery

Studies show women who are eligible candidates to receive life-saving clot-buster drugs are far less likely to receive them. And women are also less likely to have angiography (cardiac catheterization procedure) to definitively diagnosis coronary artery blockages. A study showed that, once diagnosed with heart disease, women were more likely to experience delays in being transferred to heart centers offering more advanced care. (It was not clear in the study whether delays were due to practitioners' delays in decision-making or to the woman’s refusal of care.)

Early Intervention is Key

Monitoring blood cholesterol and dyslipidemia (unhealthy cholesterol levels) is an essential early intervention. Every woman needs to know her individual risk for heart disease and what she can do to lower her risk. With blood cholesterol levels, every woman should ask her healthcare practitioner during her visit...

• How is cholesterol a risk factor for heart disease?
• Do my cholesterol levels place me at risk?
• How often should I get my cholesterol checked?
• What are the different types of cholesterol?
• What are my target cholesterol levels? How low should my LDL (“bad”) cholesterol be and how high should my HDL (“good”) cholesterol be?
• How can I improve my blood cholesterol naturally?

By learning about blood cholesterol and knowing what the numbers mean, a woman can take a more active role in managing her own health risks.

Other essential early interventions include better control/monitoring of hypertension (including systolic hypertension), better management of diabetic blood sugars, discussing and planning smoking cessation, promoting regular exercise, stress management counseling and diagnostic testing.

Diagnosing heart disease before damage has occurred may improve a woman’s outcome and her chances of survival. Researchers have demonstrated that the standard first-line test for heart disease - the treadmill stress test - renders false results in women and is not a useful tool. Combining the stress test with an echocardiogram improves accuracy rates in women. This combination testing is recommended by the Partnership for Women’s Health at Columbia University as the best first-line approach for a woman with symptoms and risk factors.

Gender Research Is Needed

Consider how gender differences and a lack of research has a profound impact on women with cardiovascular disease:

• Women's heart disease is often missed as interpretation of angiography is based on men's heart disease (WISE study NIH Jan31,06).
• Pacemakers need to be adjusted to the female heart rhythm. “To better emulate the normal physiological response, the greater Heart Rate/Work Rate Slope in women as compared with men should be considered in programming rate response” (T.Lewalter et.al, Univ. of Bonn Dept. of Cardiology and C-V Surgery’94).
• Women experience a significantly higher death rate from use of anti-arrhythmic medicine (well documented in pharmacology studies);
• Several studies demonstrate that physicians choose cheaper, less efficient, single chamber pacemaker models for women. It is not known if this is a contributing factor to women's higher death rate with pacers.
• Heart transplant patients do better when the donor heart is a male or of the same sex. (Heart Transplantation Unit at Newark Beth Israel Medical Center).
• Women have a more exaggerated response to the hormone vasopressin, which causes more vessel spasm in women and increases likelihood of clot formation. (“Decreasing Women’s Risk with Angioplasty”, K. Agarwal, Journal Cardiovascular Pharm, Jun 93).
• Women may be at higher risk than men of stroke and post-operative death following carotid endarterectomy. A study at Duke University Medical Center revealed the women's post-operative stroke and death rate was 5.3%. Men's was 1.8%. The lead author of the study, Dr. Larry B. Goldstein, states that these results were consistent with the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the question is “Why is women's death rate so much higher?” (Stroke: Journal of the American Heart Association, April 98, L. Goldstein et. al.).
• The Framingham Heart Study examined sex-specific normal values for cardiac echo. What was once read as a “normal” reading in LV wall thickness may mean a higher risk for a woman less than 5’ 2” tall. (Circ 1997 Sep 16;96:1863-73).
• EKGs are of less diagnostic value in women. (NIH)
• Treadmill stress tests have a 40% inaccuracy rate in women. (NIH)
• Estrogen use in women increases the likelihood of blood clot formation, a risk that is compounded for women who smoke or who are exposed to second-hand smoke. (AHA)
• Women taking the drug tamoxifen for breast cancer prevention or treatment were shown to have a significantly higher incidence of blood clot formation.
• Diabetes affects many more women than men. Diabetic women have double the risk of having a heart attack. Diabetes doubles the risk of a second heart attack in women but not in men. (AHA “Take Charge!”)
• Younger aged women (those between the ages of 40-59) are up to 4 times more likely to die from heart bypass surgery than men of the same age. Women's survival does not equal men’s until age 83 when both groups experience high mortality - between 9-18%. (Coronary Artery Surgery Study, 1980)
• In 1996, the American College of Cardiology and the American Heart Association published a report on the Management of Acute Myocardial Infarction (MI). The report recommends avoiding CABG as an emergency procedure after a heart attack since there is an associated 50% or higher mortality. Women oten fall into this high-risk “urgent-emergent” category since many women - and their physicians - do not recognize risk and symptoms manifestation of heart disease unique to women. Heart disease risks, while similar to men, differ for women in unique and specific ways.

Support WHF’s Purple Ribbon Campaign and promote awareness, gender-based care and research and health programs that work for women.