Recognizing Heart Risks in Black Women

Heart disease death rates are high among black women but symptoms are not always clear

(RxWiki News) While death rates for men with heart disease have dropped over the years, the same cannot be said for women. Among females, black women especially have seen even less progress.

Coronary heart disease is the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention (CDC). Men still have more heart attacks than women, but the number of incidents among middle-aged females appears to be growing while the prevalence among men of a similar age has been dropping.

A new study found that the death rate from heart disease for black women suspected of having coronary blockage was almost three times higher than for white women with the same condition. This trend may be explained, in part, by the fact that the black patients were more likely to have heart trouble symptoms that are not typical.

"See your doctor if you have abdominal discomfort."

Jo-Ann Eastwood, PhD, assistant professor at the UCLA School of Nursing in Los Angeles, and a team of researchers from medical institutions across the US followed a group of 69 black women and a group of 397 white women who had suspected ischemia (a condition in which the heart is not getting enough blood and oxygen, usually because of a blocked artery).

The participants were an average age of 57 and enrolled in the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.

The women, who had no prior history of coronary artery disease (CAD), completed symptom checklists. The questionnaire asked patients to identify heart trouble signs (for example, chest tightness, nausea, weakness/fatigue/faintness); symptom locations (e.g., chest, throat, stomach), triggers (e.g., upper body exertion, strong emotions), symptom relievers (e.g., rest, nitroglycerin) and symptom descriptions (e.g. numbness, sharpness).

All patients were imaged with an angiogram, a screening technique that uses x-rays to view the body's blood vessels. From these images, the researchers noted no significant differences in the prevalence or severity of obstructive CAD between the groups.

Black women, however, had more cardiovascular risk factors than white women, including obesity, hypertension and higher rates of diabetes.  White women had higher cholesterol measurements.

After six and nine years of follow-up, the researchers observed that the cardiovascular mortality (death) rate was 22.5 percent among black women and 8.8 percent among white women.

Overall, black women had reported more symptoms related to the stomach than to the chest, compared with the white patients. Chest-related symptoms are considered more typical of cardiovascular problems than abdominal symptoms. Chest-related symptoms include chest discomfort, pressure, tightness, fatigue and shortness of breath. Abdominal symptoms include indigestion and discomfort in the esophagus, throat and abdomen.

The researchers highlighted that black women with a low “typical” score regarding their symptoms had a significantly higher death rate compared to those with a high “typical” score — 43 percent versus 10 percent.

Dr. Eastwood told dailyRx News, “Everyone is well aware of what symptoms men have — the ‘typical’ symptoms of pressure on the chest, left arm pain and jaw pain, to name a few.”

An increase in heart awareness among men may have led to a decline in heart attack rates for them. A 2009 report in JAMA Internal Medicine of more than 8,000 men and women aged 35 to 54 showed that the men’s heart attack rate dropped from 2.5 to 2.2 percent, compared to women’s rate, which climbed from 0.7 to 1 percent. (The authors of this prior study compared differences between two time periods: 1988-1994 and 1999-2004.)

Because black women may have symptoms that are not typical, Dr. Eastwood indicated that this may be key as to why black women may not receive care “ accordance with best practice guidelines as often as white women."

"These findings inform clinicians that atypical symptoms of CAD are common in women and even more so in black women and practitioners should carefully evaluate them,” Dr. Eastwood told dailyRx News. “This may increase early diagnosis and treatment and decrease delay-related consequences.”

She added that chest pain symptoms may be vague in women. Research has been conducted to define “typical” symptoms for women which has led to descriptors such as diaphoresis (sweating), fatigue, shortness of breath, nausea and more diffuse discomfort to the throat, abdomen and back.

“Complaints of abdominal discomfort should not be ignored and may be a sign of cardiac problems in black women,” Dr. Eastwood said. “Trust your instincts. Women know their bodies. Seek treatment as soon as possible to obtain the best care and reduce the chances of living a less than optimal quality of life.”

This study was published in September in the Journal of Women’s Health.

The research was supported by the National Heart, Lung, and Blood Institutes, the National Institute on Aging, General Clinical Research Center, the National Center for Research Resources, the Gustavus and Louis Pfeiffer Research Foundation, the University of California Los Angeles School of Nursing and the Barbra Streisand Women's Cardiovascular Research and Education Program.

Review Date: 
September 16, 2013