Special Section

Listen To Your Heart

Feel something, say something; Here's why women's heart disease is so dangerous.
By By Rebecca Kirkman —

Shari Sudano knew something wasn’t right. The then-44-year-old single mother from Eldersburg had unusual feelings of indigestion on and off for a week, and felt out of breath from simple activities. “It got worse,” says Sudano. “I felt tired, and just walking up a flight of steps would make me get out of breath—which wasn’t normal.”

About a week after her symptoms began, she went to the emergency room for chest pain. She was diagnosed with coronary artery disease in May 2014, and a cardiac catheterization at The Johns Hopkins Hospital subsequently revealed a 95 percent blockage in her main artery, which was opened surgically with a stent.

Although she had some family history of heart attacks, Sudano says she wasn’t aware of the risk for women of her age. “I was healthy, I exercise, I don’t smoke—what did I have to worry about? I definitely don’t fit the stereotype.”

Then, just a few months after her first procedure, Sudano felt the familiar symptoms return. “When I told the doctor, he sort of chuckled,” she says. But she listened to her gut and was persistent. After another trip to the emergency room, Sudano underwent double-bypass surgery. Now, she hopes sharing her story as an American Heart Association Go Red Ambassador may save other women’s lives.

“I can’t express this enough—if you feel something, talk to your doctor, be your own advocate, and don’t give up.”

A Sobering Truth

While it’s often thought of as a man’s disease, heart disease is the No. 1 killer of women, causing one in three deaths each year—that’s about one woman every minute, according to the American Heart Association. And despite the public focus on breast and uterine cancers, heart disease, in fact, kills more women than all cancers combined.

But most women haven’t gotten the memo: Only one in five believes heart disease is her greatest health threat. That’s partly due to low awareness of risk factors and symptoms, which are often different in women than men.

“Men are more likely to be diagnosed with heart disease, even though women make up more than half of all the fatalities,” says Dr. Christina Stasiuk, Cigna’s national medical director for health disparities. “And after a heart attack, women are more likely to die of heart disease than men.” That inequality in outcomes is what’s called a health disparity.

“A health disparity is an avoidable and unfair difference . . . between segments of the population,” says Stasiuk, who worked as an internist for many years before joining Cigna.

Through her position at Cigna, Stasiuk works to improve these sobering statistics by promoting health equity, or the pursuit of eliminating health disparities and inequalities, work for which Cigna was awarded the Surgeon General’s Medallion in 2012.

“If you take this big bucket of women and you divide them more, Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women. If you look at the statistics, only three in 10 Hispanic women have ever been told that they’re at higher risk,” she says. “And if you look at the bucket of African-American women, they have higher rates of blood pressure, which puts them at higher risk for developing cardiovascular disease than white women, but only one in five African-American women actually thinks she’s at risk of heart disease.”


How Go Red for Women champions women's health

Jennifer J. Stearman is the woman behind the American Heart Association’s Greater Baltimore Go Red for Women Luncheon. As the event chair, she works to bring awareness of women’s heart disease to the Baltimore area. She’s also a partner at law firm McGuireWoods, where she practices in corporate finance with a focus in the energy and health care industries. We asked her why she’s passionate about the movement, and how others can get involved.

What are the campaign's top priorities? Our goal is to save lives by increasing awareness around heart disease and stroke and to inspire and educate women to take charge of their heart health. We believe that we can achieve these goals through partnerships, education, fundraising, and by positively influencing everyday lifestyle choices and actions.

Why are you passionate about the mission Each year, heart disease and stroke are the causes of one in three deaths. This is a statistic that we can change, because 80 percent of cardiac events can be prevented with education and lifestyle changes. My mother, my sister, my niece, and every woman I know motivate me to participate in this important campaign to improve women’s health.

Why is it powerful when women unite for the cause? For 11 years, the American Heart Association’s Go Red for Women campaign has been the driving force of heart health for millions of women. It’s a nationwide initiative that celebrates the energy, passion, and power of women by banding together to listen to our bodies, knowing the warning signs of heart disease, and taking action.

How can Maryland women get more involved? There are many ways to get involved with Go Red in Maryland and celebrate heart health year-round. In February, we celebrate American Heart Month and Friday, February 5, is National Wear Red Day. On this day, we bring attention to the staggering statistics. We encourage everyone to wear red, raise their voices, know their cardiovascular risk, and take action to live longer, healthier lives. Encourage your family and friends to take small steps toward healthy lifestyle choices. Get informed about the risks of heart disease and stroke. Learn the red flags and know your heart health story.


  • Since 1949, the AHA has spent more than $3.3 billion on research into cardiovascular diseases and stroke.
  • AHA ranks second only to the federal government in funding cardiovascular and stroke research. In all, the association spends nearly 80 cents of every dollar on research, education, and community-outreach programs.
  • The AHA’s research programs have contributed to many scientific advances now used by doctors and surgeons around the world, including the first artificial heart valve, CPR training, implantable pacemakers, treatment for infant respiratory distress syndrome, cholesterol inhibitors, microsurgery, and drug-coated stents.
  • Funds raised also support public awareness and activities including Go Red Luncheons, Circle of Red, and Men Go Red.

Understanding Risk

Heart disease in women is unique in many ways, from risk factors to symptoms. The Johns Hopkins Women’s Cardiovascular Health Center brings together specialists and other health care providers with experience treating women’s bodies, making them more in tune to the risks and signs of heart disease that are unique to their patients.

“There are some differences in risk factors in women and men, and not all providers are aware of that,” says Dr. Erin Michos, a cardiologist and associate professor of medicine at The Johns Hopkins University School of Medicine. “So it’s helpful to have providers who have experience in treating women.”

While the traditional risk factors—like blood pressure, cholesterol, and smoking—are just as important in women as men, many people don’t realize that some of those factors cause greater risks to women. “Diabetes causes a three- to seven-fold increased risk of heart disease in women, compared to a two-fold increase in men,” says Michos. Similarly, women who smoke are three times more likely to develop heart disease, while, for men, the risk doubles.

Pregnancy and menopause outcomes are important risk factors that providers often overlook, says Michos. “Women who’ve had a history with preeclampsia [a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys] have nearly double the risk of heart attack and stroke, even 10 to 12 years after the pregnancy,” explains Michos. “And they have a greater risk of dying in the long-term. So this is a really important group that we need to identify.”

Another risk factor associated with pregnancy is gestational diabetes. Even if a mother’s blood sugar returned to normal after giving birth, she is more likely to develop Type 2 diabetes within 10 years.

Not all risk factors are physical. “We know emotional and mental stress is a risk factor,” says Michos. “Divorce, especially multiple divorces, is a strong risk factor for heart disease.” In fact, divorced women are 24 percent more likely to have a heart attack than women who remain married, according to a study by Duke University. And for those with two or more divorces, the risk jumps to 77 percent. “Going through that stress, it raises your heart rate. There’s a big mind-body connection, and emotional and mental stressors seem to confer more risks to women’s hearts than men’s hearts,” says Michos.Li

Listen To Your Heart 2

Surprising Symptoms

One of the potential reasons more women die from heart disease than men is that the symptoms of a heart attack in women can be mistaken for other common ailments. Women often experience nausea, jaw or neck pain, lower back pain, shortness of breath, and fatigue in the days leading up to a heart attack. Women who are unaware of their symptoms’ association with heart disease may let the problem go unchecked, or even worse, doctors may not suspect heart disease due to the patient’s age or fitness level.

“Women can certainly get the classic angina, heaviness in the chest that goes to the neck and the arms, when you’re walking and exerting yourself getting short of breath,” says Michos. “But women are far more likely to get atypical symptoms. Sometimes they don’t have chest discomfort at all.”

More women than men also suffer from angina without any significant blockages. A condition called microvascular angina, which affects the tiny coronary arteries that supply oxygen to the heart muscle, is more common in women than men. Because it occurs without the type of large blockage to main arteries that can be cleared with stents and bypasses, it often goes undetected because it doesn’t show up the same way on an angiogram.

“With microvascular disease, you can have more atypical symptoms—you have chest pain that can come on with rest rather than exercise, or it can come on with emotional stress, such as a fight with your spouse, rather than a physical stress,” says Michos. Combined, these factors make the condition trickier to diagnose. “Microvascular angina can be both very limiting in terms of symptoms, and it’s associated with higher risk [of heart attack compared to women without angina], so it’s important that women with the condition are recognized.”

Because of the unique symptoms, Michos recommends women see a doctor who’s familiar with women’s heart disease. “They’re just a little more sensitive to some of these issues.”


Symptoms unique to women.

We’ve all seen a heart attack on TV—an older gentleman clutches his fist to his chest and passes out. But in reality, symptoms of heart disease come in many forms, especially for women. And remember to trust your gut—if you suspect any problems, tell your doctor about your symptoms and that you’re concerned about your heart.

  • Shortness of breath: Women often struggle to breathe a few weeks before an attack. If you’re doing normal physical activity and suddenly experience shortness of breath, it may be a reason to be worried.
  • Back pain
  • Unusual pain in the lower back could signal stress to the heart muscle.
  • Jaw pain
  • Especially in women, pain due to heart strain can radiate to the neck, jaw, and back. If you experience pain in one of these areas related to physical activity, pay attention.
  • Nausea
  • Flu-like symptoms are often reported days before a heart attack.

Rising To The Challenge

But there is some good news: The overall mortality rate is going down among women. “What’s concerning is there’s actually been a stagnation or plateau in this decline for younger women, ages 25 to 54,” says Michos. So while fewer women overall are dying from heart disease, the rates for younger women are staying the same. That’s why it’s important for young women to take charge of their health. And a good start is to get screened every four to six years, starting at age 20.

Also important is knowing your numbers, like blood pressure and cholesterol. “I see these really educated women who take care of their whole family’s finances and all their kids’ soccer schedules and often are working full-time, and I ask them, ‘What’s your cholesterol?’ and they’re like, ‘I don’t know, I think it’s good,’” says Michos. “I encourage women to know their numbers and track them, and be an active partner in engaging their doctor in their health.”

Cardiovascular disease statistics can be intimidating, but it’s important to remember that the disease is preventable. While prevention includes a big-picture look at your lifestyle, there are a few steps you can take to get started.

In addition to knowing your numbers, Cigna’s Stasiuk recommends lifestyle changes like getting active, eating better, stopping smoking, and limiting alcohol. “It sounds simple, but you can’t do seven things at once,” Stasiuk advises. “The important thing is to pick which ones are important to you, and do what you think you can do. Start small, get support, get information, and track your progress.”

When it comes to prevention, it’s important to rally the support of your community. “We know that 80 percent of health care decisions are made by women, and we also know that the health of a woman’s village is dependent on a woman, because the woman still does the vast majority of grocery shopping, cooking, et cetera,” says Stasiuk. “One of the biggest challenges is for women to carve out time for themselves.” She recommends women reach out to their family and friends for help “so that the time that a woman typically spends doing for others, others can do for her, and she can take that time to think about her health.”

Listen To Your Heart 3


How to stop heart disease before it starts.

Heart health begins with a healthy lifestyle. Dr. Erin Michos, a cardiologist at the Johns Hopkins Women’s Cardiovascular Health Center, shares an A-B-C approach to heart disease prevention.

Assess Risk

Ask your doctor to measure your risk factors, which can be used to determine your 10-year risk. Remember, risk calculators don’t include many unique factors, like pregnancy and family history. Blood Pressure Management

Have your blood pressure measured regularly, and work with your doctor to achieve an optimal level—now considered to be less than 120 over 80. Cholesterol Management and Smoking Cessation

Cholesterol levels—both good and bad—are important numbers in assessing your health, but many women don’t know them. And if you smoke, the increased risk of heart disease is just one more reason to stop.

Diabetes Prevention

Eat a healthy, Mediterranean-inspired diet rich in fruits, veggies, grains, and lean protein to prevent diabetes and improve cardiovascular health. Exercise

Moderate physical activity is associated with a decreased risk of heart disease in women. Aim for 5,000 to 10,000 steps a day. Family History

Talk with your doctor about history of stroke and heart disease in your family. If both parents have suffered from heart disease before the age of 55, it could raise your risk as much as 50 percent.

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