For general information or to find a doctor at Montefiore, please call 1-800-MD-MONTE
For credentialed members of the media, please call 718-920-4011

When It Comes To Matters Of The Heart Gender Makes A Difference

NEW YORK CITY,NY (February 2000)-- While men and women are created equal, as the expression goes, they are really not the same. Nowhere is this more apparent than in matters of the heart.

"Many risk factors for heart disease and effective approaches to treating it should be gender specific," says Lynne V. Perry-Bottinger, M.D., a clinical and interventional cardiologist at Montefiore Medical Center in the Bronx, "because the physiology and symptomology are different in men and women." Yet for years, the medical establishment has taken a ‘one size fits all’ approach to guidelines governing the diagnosis and treatment of heart disease in women.

"The assumption was that if it worked for men, it would work for women," Dr. Perry-Bottinger says. But as a woman, mother, and cardiologist with a special interest in gender-based medicine, Dr. Perry- Bottinger believes this assumption is taking its toll. "For women, the death rate from heart disease is greater than for men, and women have higher complication and mortality rates after being treated for heart attacks than men."

Today, cardiovascular disease is the leading cause of death among women in the United States, claiming far more lives annually than the next 16 causes of death combined, including all forms of cancer. And one-third more women will have a cardiovascular problem before they reach 65 than will men.

According to Dr. Perry-Bottinger, there any many reasons for the discrepancies in care -- some well-documented and others more theoretical. They include the following:

 

• Women often fail to display the "classic"signs of a heart attack. Instead of crushing chest pain radiating to the shoulder, they may suffer other kinds of symptoms, such as jaw pain, abdominal pain, shortness of breath, profuse sweating and fatigue -- making swift diagnosis difficult.
• According to a Gallup poll, 88% of primary-care physicians didn’t know that symptoms of heart attacks in women differ from men; 33% didn’t know that heart attacks are the biggest killer of women.

Traditionally, women have been the gatekeepers of medical care for their families, frequently allowing their own health to take a back seat to that of their spouses, children, and parents. Women need to focus more on their own health care needs. The best way for them to prevent heart disease is to control the risk factors: smoking, lipid levels, blood pressure, and weight.

Prior to 1993, most clinical trials testing new drugs and devices did not include women of childbearing years. Even today, most studies are conducted with male subjects. So, little, if any, clinical data exists to support observations that drugs and devices work differently in men and women.

Dr. Perry-Bottinger points out that a woman’s heart and vascular system differ significantly from a man’s. "Women have smaller hearts and smaller coronary arteries. The interplay of her anatomy and hormones also influences her cardiovascular system in unique ways. These differences affect virtually every aspect of a woman’s care."

Dr. Perry-Bottinger has taken this information and added it to her arsenal in the crusade to educate peers and patients about gender issues in heart disease. In December, 1999, she and Dr. Michelle N. Johnson, also a cardiologist at Montefiore Medical Center, chaired a one-day medical education symposium on gender issues in heart disease. "Controversies in the New Millenium: How to Incorporate Gender-Based Medicine to Enhance Your Practice" attracted more than 225 physicians from the tri-state area. "The response was tremendously encouraging," says Dr. Perry-Bottinger.

Drs. Perry-Bottinger and Johnson have also extended their outreach efforts beyond the hospital walls into surrounding communities where they routinely participate in Montefiore’s Healthy Heart series. The series features informative lectures geared toward consumers, along with health screenings. "The goal of Healthy Heart is to help women recognize the risks for heart disease and be alert to the symptoms," says Dr. Perry-Bottinger. When it comes to matters of the heart, gender makes a difference.

About Dr. Lynne Perry-Bottinger
Dr. Perry-Bottinger is no stranger to matters of the heart, having been raised in a family of physicians. "I guess you could say cardiology was a natural progression for me. Every Friday evening, my father [an interventional cardiologist] would sit my siblings and me down -- all ten of us -- for a one-hour lecture about the heart. Now that I have the added benefit of experience, I want to share what I’ve learned to help make a difference in the hearts of women everywhere."

Dr. Perry-Bottinger is board-certified in cardiology and internal medicine. She received her medical degree from Yale University Medical School in 1986, and was a postdoctoral clinical fellow in cardiology at Johns Hopkins University, 1990-1994. She is a graduate of Harvard College (1982). Dr. Perry-Bottinger is multi-lingual, speaking English, German, French, Spanish and Yiddish and frequently uses her language skills in her practice. She regularly participates in professional conferences, contributes to professional publications, gives lectures, and talks before community groups. In her spare time, she enjoys playing with her sons and gardening.

What You Can Do to Prevent Heart Disease:

• Exercise and/or walk for 30 minutes each day
• Eat healthy foods: multi-grain cereals and breads, brightly colored vegetables and fruits, salmon, walnuts, garlic, skinless chicken, low-fat yogurt
• Avoid salt, sugar, and fatty foods
• Get your blood pressure, cholesterol, HDL, LDL, and triglycerides checked regularly
• Report inherited risks to your physician: diabetes, heart disease, high blood pressure ,
• Take an aspirin a day as advised by your physician
• Make sure you’re getting enough vitamins
• Drink plenty of healthy fluids: 8 glasses of water a day, orange juice, purple grape juice, green tea

Warning Signs of a Heart Attack in Women:

• Chest pain that radiates to shoulder and forearm
• Pain in jaw, abdomen, back
• Fatigue, profuse sweating, fluttering heart or rapid heart beat
• Numbness in the extremities
• Shortness of breath

Surprising Statistics About Women and Heart Disease:

• Heart attack is a leading killer of American women, proving fatal each year for ten times as many women as breast cancer.
• Nearly half (44%) of all American women die of cardiovascular disease
• 8,000,000 American women are currently living with heart disease -- 10% of women aged 45 to 64, and 25% of women over age 65.
• In 1998 in New York State, women 45 and over with heart disease numbered 567,987 (45-64: 203,102; 65+ : 364,889)
• Each year, 440,000 American women have heart attacks; 230,000 die from heart attacks
• Women tend to underestimate their risk of coronary disease, and don’t take the disease as seriously as they should. (It is estimated that close to 80% of women don’t realize that heart disease is the biggest killer of women)
• Not only have drugs and devices been designed based on male physiology, but so have diagnostic tests
• Women who have high triglycerides and high LDL levels (bad cholesterol) are more at risk then men for heart disease and stroke
• Diabetes has only recently emerged as a much stronger risk factor for heart disease in women then men, contributing to as many as 1 in 5 post-menopausal heart attacks. Unfortunately, most physicians do not recognize the connection and, therefore, do not counsel their patients appropriately.
• Gender-based medicine is a relatively new phenomenon. The differences between men and women suffering from heart disease was not a focus until approximately ten years ago.

Women at Risk for Heart Disease:

• Women who have smoked and/or taken birth control pills are far more likely to have heart attacks than women who do neither. Smokers risk having a heart attack 19 years earlier than nonsmokers.
• Women with diabetes are two to three times more likely to have heart attacks.
• Women with a family history of heart disease, diabetes, smoking, obesity, high blood pressure, elevated cholesterol are at risk for heart disease
• Lack of physical exercise, post-menopausal age, and African-American heritage make heart disease more likely
• The age-adjusted rate of heart disease among African-American women is 72% higher than that for white women. African American women aged 55-64 are twice as likely as Caucasian women of the same age group to have a heart attack, and they are 35% more likely to suffer from coronary heart disease, which causes heart attacks.
• A first heart attack will more likely kill a woman than a man, and 42% of women who have heart attacks die within a year compared to 24% of men.

(Statistics from CDC's National Center for Health Statistics, the American Heart Association, and the National Heart, Lung, and Blood Institute.)

Printer Friendly Page

Vladimir Kvetan, MD,

Chief, Critical Care Medicine

We treat the most fragile patients in Montefiore’s medical, surgical, neurological and cardiothoracic intensive care units, but critical care at Montefiore also extends beyond those areas. Our unique "ICU Without Walls" service is a rapid response team of intensivists and respiratory therapists who are on call 24/7 to evaluate and treat patients in need of critical care in other areas of the hospital.

Media queries for this expert

Media queries for other experts at Montefiore

Schedule An Appointment | Health Library | Directions | Careers | Sitemap
Newsroom | Newsletters | For Health Professionals | Privacy Policy

© 2008 Montefiore Medical Center.