Heart disease is the number one cause of death for women. It accounts for one in four female deaths, and yearly, more women than men die from it. Heart care for women is an important focus for healthcare providers, and providing risk assessment for and education on prevention of heart disease is a proactive approach to take, as is staying informed on new FDA-approved drugs for when pharmacological treatment is needed.

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Women with heart disease often do not realize it because they have had no symptoms, or the symptoms they have experienced are not those typically associated with a heart attack. This results in many cases where heart damage already occurred by the time women seek medical care. In 64% of coronary heart disease fatalities in women, sudden death occurred with no previous symptoms.

Some women may have a heart attack without chest pain, though many do experience some sort of pain, pressure, or discomfort. Since women tend to have small vessel heart disease or microvascular disease, they may experience chest pain that presents as a feeling of pressure or tightness, as opposed to more dramatic crushing pain that is commonly associated with heart attacks. Other heart attack symptoms unrelated to chest pain may be experienced, such as nausea, vomiting, discomfort in the neck, jaw, shoulder, upper back, or abdomen, pain in the right arm, shortness of breath, sweating, lightheadedness/dizziness, or unusual fatigue. Symptoms in women may occur more often when they are resting or even sleeping. Psychological stress can even be a trigger for heart attack symptoms in women.

Women should be informed about the risk factors they have for heart disease. Those who are under 65 and have a family history of heart disease should be especially aware of the risks. Nearly half of all individuals in the United States have at least one of the primary risk factors for heart disease, which are smoking, high LDL cholesterol, and hypertension. Metabolic syndrome and diabetes can each have a greater impact on heart health in women than in men. Additionally, women’s hearts may be more affected by stress and depression. A woman's long-term risk of hypertension and diabetes can be increased after complications during pregnancy, such as gestational diabetes or hypertension; both the mother and child in these situations can be at risk for development of heart disease. Women may also be susceptible to development of microvascular disease due to low levels of estrogen after menopause.

Inform women about the type of symptoms they should be aware of and advise them to do what they can to lower their risks. They should avoid smoking and excessive alcohol use, increase physical activity, maintain a healthy weight, and manage other medical conditions that can increase risk. Early diagnosis of any condition is vital, so women should be screened for hypertension and/or diabetes, have their cholesterol and triglycerides checked, and be educated on making positive lifestyle changes. Make recommendations to engage in moderate exercise for 30 to 60 minutes most days of the week; to maintain a diet low in cholesterol, sodium, and saturated fat; and to find positive ways to cope with and lower stress.

When prescribed medications are necessary, the importance of taking them appropriately must be emphasized, such as in the cases of antihypertensive drugs, anti-coagulants, and aspirin. Often, reduced blood flow to the heart muscle results in angina in women, which is treatable through various therapies, such as those included in PDR’s Angina Treatment Options table (content based on FDA-approved labeling as of February 2014 and included as part of the 2015 PDR Nurse’s Drug Handbook). New FDA approvals continue to emerge that offer even more therapeutic options to manage heart disease and related conditions. Recent examples include:

• Prestalia (perindopril arginine and amlodipine), for treatment of hypertension
• Savaysa (edoxaban), for treatment of deep vein thrombosis, pulmonary embolism, and risk of stroke and systemic embolism due to atrial fibrillation
• Sotylize (sotalol HCl), for treatment of ventricular arrhythmias, such as sustained ventricular tachycardia, that in the judgment of the physician are life threatening
• Zontivity (vorapaxar), for reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction or with peripheral arterial disease
• Eliquis (apixaban), for prevention of stroke and systemic embolism resulting from nonvalvular atrial fibrillation

Helping to inform women on their medical conditions and staying knowledgeable about emerging prescription therapies to combat those diseases are key to preventing and reducing the incidence of heart disease in women. Keep informed by using PDR.net as a resource for thousands of available products. Stay current on alerts and specific product labeling by providing updated contact information. To have updated drug information, full labeling, and safety warnings integrated into your electronic prescribing system automatically, and at no cost to you, be sure to request PDR drug data feeds, including PDR BRIEF.

Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer
PDR