Am Fam Physician. 2004 Sep 15;70(6):1026-1028.
Heart disease is the leading killer of American women.1 One in three American women dies of heart disease, and related health care costs are estimated at more than $57 billion per year.2 Yet most women don’t know that heart disease is their greatest health threat. Research shows that women worry more about cancer—especially breast cancer—than about heart disease.3 Only 9 percent of women 45 to 64 years of age name heart disease as the condition they fear most; 61 percent name breast cancer.4
Because many women believe that heart disease affects mostly men, they don’t take their risk seriously or personally. Yet certain cardiac risks are actually greater in women than in men. Women have a higher risk of death after a myocardial infarction; 38 percent of women die within a year of a myocardial infarction compared with 25 percent of men.5
As family physicians, we can raise awareness about steps our female patients can take to prevent heart disease at any age. Heart disease, which includes coronary artery disease (CAD), congestive heart failure, angina, and other conditions, accounted for 366,000 deaths in women in 2000. Approximately 40,000 women died of breast cancer that year.6
The U.S. Department of Health and Human Services and other organizations are sponsoring a national campaign called “The Heart Truth” to raise women’s awareness about their risk of heart disease. It is aimed at women 40 to 60 years of age, and its goal is to encourage women to talk with their physicians and take action to lower their risk for heart disease. The National Heart, Lung, and Blood Institute initiated the campaign in response to data indicating that many American women fail to connect risk factors for heart disease, such as high blood pressure and high cholesterol levels, with their own chance of developing the disease (National Heart, Blood, and Lung Institute, unpublished data, 2002).
The campaign organizers cannot deliver this message alone. The Heart Truth has worked with First Lady Laura Bush, who has championed the cause at appearances around the country. She tells women that “each one of us should talk to our doctors to find out about our risk for heart disease and take action to lower our risk.” National and local partnerships are needed to help reach women across the nation. The U.S. Department of Health and Human Services is pleased to be working with the American Heart Association and Women Heart: the National Coalition for Women with Heart Disease, which are founding partners of the campaign.
The Heart Truth has an exciting and attention-getting symbol: the red dress. Its message is, “Heart disease doesn’t care what you wear, it’s the number one killer of women.” The symbol reminds women that no matter how good they look on the outside, they may be at risk for heart disease and should be assessed. The message is serious, but it is hopeful, too. Women can take steps today that can lead to “heart-healthy” tomorrows.
As a family physician, you can help spread The Heart Truth by making cardiovascular disease (CVD) and CAD risk factor screening an integral part of your work. You can use age-appropriate CVD and CAD assessment tools to record the results for every female patient. Online risk-assessment tools are available (http://hin.nhlbi.nih.gov/atpiii/atp3palm.htm and http://www.nhlbi.nih.gov/guidelines/cholesterol/profmats.htm).
The following key items should be a part of your assessments and documentation:
Body mass index and waist circumference
Complete lipoprotein panel (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels)
Fasting blood glucose level (to screen for diabetes)
Physical activity habits
Family history of heart disease
Many women begin to develop risk factors for heart disease at midlife. In women 55 years and older, age is considered a risk factor for heart disease. However, it is important that both younger and older women receive assessment for and counseling about heart disease.
Be bold about telling your patients when they have risk factors for heart disease and give them the information they need to lower those risks. Monitor your patients’ progress in achieving heart-healthy lifestyle modifications and medication compliance.
You also can give your patients The Heart Truth campaign materials, such as The Healthy Heart Handbook for Women. These materials are available online (www.HeartTruth.gov).
CRISTINA V. BEATO, M.D., F.A.A.F.P., is acting assistant secretary for health at the U.S. Department of Health and Human Services, Washington, D.C.
Address correspondence to Cristina V. Beato, M.D., U.S. Department of Health and Human Services, 200 Independence Ave. SW, Room 716G, Washington, DC 20201. Reprints are not available from the author.
1. American Heart Association. Heart disease and stroke statistics, 2003 update. Dallas: American Heart Association, 2002:4.
2. Sandmaier M. Healthy heart handbook for women. Bethesda, Md.: U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, 2003.
3. Mosca L, Jones WK, King KB, Ouyang P, Redberg RF, Hill MN. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women’s Heart Disease and Stroke Campaign Task Force. Arch Fam Med. 2000;9:506–15.
4. Assessing the odds [Editorial]. Lancet. 1998;350:1563.
5. Thom TJ, Kannel WB, Silbershatz H, D’Agostino RB. Cardiovascular diseases in the United States and prevention approaches. In: Fuster V. Hurst’s The heart. 10th ed. New York: McGraw-Hill, 2001:3–7.
6. Centers for Disease Control and Prevention. National vital statistics reports. Deaths: leading causes for 2001. Accessed online July 12, 2004, at: http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_09.pdf.
Copyright © 2004 by the American Academy of Family Physicians.
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