It was early summer when Daryl Dinal started walking every day to her new job in New York City. After 20 years raising three sons as a divorced mother, the 52-year-old had finally reached what she called "the least stressful time in my life." She was planning her September marriage to a man she’d met through volunteer work. The chest pains began in June as she trekked the hot city blocks. She ignored them, blaming the humid Manhattan weather for the discomfort.
But they increased. Despite growing fatigue and irritability, a cardiogram showed nothing. Her blood pressure was normal. Then, one morning the week before her wedding, she collapsed in her apartment in agony.
“I was making the bed when the chest pain knocked me to the dresser,” said Dinal.
An emergency cardiac catheterization revealed that her left main artery, where it leads into the heart, was blocked.
“I had a pinhole where the oxygen goes into my heart,” she said. “I had what is called ‘the widowmaker.’"
'I may have been in denial'
What Dinal discovered shortly after was that she, a long-time smoker, was diabetic.
“I may have been in denial,” she said. “I never had a conscious thought about my heart.”
She's not alone. Ask most women what disease worries them and they'll respond: "Breast cancer. Stroke. Alzheimer's."
What Dinal and other women don't realize is that heart disease is killing them faster than all cancers combined. Cardiovascular disease is the No. 1 killer of women and men, according to the American Heart Association. Every year, 250,000 women die from coronary heart disease and nearly 500,000 women die from cardiovascular disease, which includes all heart disease and strokes. That's 1,400 women dying each day -- a statistic that's only recently been gaining attention from women and their doctors.
Comparatively, 40,000 women die each year from breast cancer, the second leading cause of death among women, according to the American Cancer Society.
"There is a misperception that heart disease is a male problem," said Dr. Norma Keller, chief of clinical cardiology at Bellevue Hospital in New York, during a recent media briefing for the American Medical Association. "But we lose more women each year from heart disease than men."
Keller called on the medical community to get women thinking more about their hearts.
"Awareness of heart disease has had a major impact on men's health in the last decade, but there's been virtually nothing done to lower the numbers on women and heart disease," she said.
Higher death rate for women
In the last 20 years, heart disease has become an even bigger problem for women because of rising smoking rates, the aging baby-boomer generation and obesity, said Dr. Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic in Rochester, Minn.
Since 1980, the number of men who die each year from cardiovascular disease has dropped from almost 510,000 to just over 420,000 in 2001. But women's deaths have increased from an estimated 470,000 to almost 500,000, according to data from the American Heart Association.
Because even medical professionals don't realize the dangers of heart disease for women, there's often less of a sense of urgency when a woman walks into an emergency room with symptoms.
"Women are more likely to die in the first 30 days after a heart attack, particularly younger women," said Hayes. And, they are less likely to be prescribed beta blockers, drugs that are used for controlling blood pressure and heart attacks.
If a woman is under the age of 50, she is at a higher risk of having a heart attack misdiagnosed in an emergency room, making her twice as likely to die as a man the same age, said Hayes.
Even if she is correctly diagnosed, 38 percent of female patients will die during the first year after a heart attack, compared to 25 percent of men, studies indicate.
'Silent and sneaky'
When it comes to cardiovascular disease, women's symptoms can be different from men's, a key reason why heart illnesses often go undetected in women.
Common symptoms of a heart attack include:
- Chest pain
- Shortness of breath
- Excessive sweating
Rather than the arm-grabbing agony felt by men, women are more likely to experience shortness of breath, sweating and palpitations, as well as nausea or queasiness -- symptoms that can be confused with stress, says Keller.
Women are also more likely to have complications during surgery and more likely to have recurrent heart attacks.
"It's still a mystery why," said Dr. Barbara LaPetri, former cardiology specialist at Catholic Medical Center Hospital Center in Elmhurst, N.Y. "Women may have smaller arteries or because they get heart disease at a later time. It's silent and sneaky."
In general, women are older when they develop heart problems -- usually 10 years after menopause since natural estrogen offers protection against heart disease, said Keller. Hormone replacement therapy, once hoped to have a protective effect on women's hearts, actually increases the risk, research has found.
Know your numbers
Rather than wait for a sign that something's wrong, women need to recognize and reduce key risk factors, say doctors. A frightening statistics underscores why -- an estimated 64 percent of women who died suddenly of coronary heart disease had no previous symptoms, a study finds.
Women are diligent about getting their annual PAP smears and mammograms, but they should also make sure they know their blood pressure, cholesterol, and glucose levels.
Smoking is the most significant risk factor for heart disease. The 22 million American women who smoke have a two-to-four times greater chance of dying suddenly of a heart attack than a non-smoker, said Keller.
Being overweight and diabetic also seriously increases the odds of developing heart disease. About three-quarters of people with diabetes die of some form of heart or blood vessel disease, according to the American Heart Association.
"If all women exercised regularly, had normal weight, drank moderately and didn't smoke, it would eliminate 82 percent of the risks," said Hayes. "But only 3 percent of women do these things."
As for Dinal, after a seven-week recovery, she stopped smoking and started on a number of different heart drugs. She continues to walk daily, watches her weight and sees her regular doctor every three months for blood sugar, cholesterol and liver tests. She visits her cardiologist annually.
Now, seven years later, she's celebrating a happy marriage and her first grandchild.
"Back then, I had to worry about my kids and I was too busy to think about my heart," she said. "Now I feel good."