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At Jefferson Cardiology, Dr. Michael Nathanson Is Empowering Women to Improve Their Heart Health
By Nancy Kennedy

Women’s heart health differs from that of men in many significant ways, but what the genders have in common is that heart disease is the #1 cause of death for both. There is a tendency for women to give greater attention to breast cancer, and perhaps to fear it more, but the reality is that women are much more likely to develop heart disease than breast cancer. The good news is that heart disease is largely preventable and within one’s own control, and Michael Nathanson M.D., a board-certified cardiologist with Jefferson Cardiology Associates, wants to empower women to take charge of this and improve their heart health.

Women experience heart disease differently, he says. “Women tend to have heart attacks later in life than men,” says Dr. Nathanson. “On average, they have a first attack when they are about ten years older. For women, heart attack is mostly a post-menopause phenomenon.” In addition, says Dr. Nathanson, heart attacks are likely to be deadlier for women – more severe, and more likely to be fatal. There are numerous reasons for this. A primary one is that symptoms of heart disease are often more subtle in women, and as a result, they are less likely to be recognized as heart symptoms. Fatigue, shortness of breath, a general feeling of weakness and nausea are among the symptoms that women often experience, rather than the obvious “classic” squeezing chest pain that radiates to the left arm. Because the more subtle symptoms can also be indicative of other problems, or simply be due to fatigue, women are less likely to seek medical help. Thus, their heart disease goes undetected.

Dr. Nathanson states that when women do seek help in the Emergency Room or at their physician’s office, they may not be treated as aggressively as men are treated. He attributes this to the fact that women’s symptoms are not associated with exertion, as men’s are. The delay in identification of heart disease in women means that when they are finally diagnosed, their disease is more advanced, they are older and they may have acquired additional risk factors that complicate the picture, such as diabetes, or hypertension. This is the reason why heart attacks tend to be deadlier for women. According to the American Heart Association, 26% of women age 45 or older will die in the year following a first heart attack, compared to 19% of men.

One in four women with heart disease have “microvascular” angina, which means that the tiny arteries in the heart are occluded by plaque. But these small arteries can’t be seen on a cardiac catheterization or CT scan. “We are unable to visualize the decreased blood flow at that microscopic level,” explains Dr. Nathanson. “It actually appears normal. One of the ways we detect microvascular disease is by testing the way blood flow responds to medication; we diagnose it clinically but it’s a difficult diagnosis.”
Risk factors for heart disease include:

  • Family history
  • Sedentary lifestyle
  • Age over 55
  • High blood pressure
  • High blood cholesterol level
  • Diabetes
  • Smoking
  • History of medical problems during pregnancy: gestational diabetes or high blood pressure

Obesity is itself not a primary risk factor, Dr. Nathanson says, unless it is the abdominal, “apple” pattern of fat; obesity is however, related to many of the other risk factors.

Dr. Nathanson emphasizes that a major risk factor is a sedentary lifestyle. “Those who get no regular exercise are at risk for heart disease, but fortunately changing this does not require a major alteration. It only takes a modest amount of exercise to have a significant effect: the AHA recommends a 20-30 minute walk, five times a week. Most people are capable of that. Those who make modest changes actually gain the greatest benefit.”

Women need to become aware that heart disease is a greater risk to them than cancer, and they need to be vigilant about their heart health. Most heart disease is preventable, as it is mostly due to risk factors that can be modified. “You have a lot of control over your heart health,” Dr. Nathanson says. “The same is not true for most other diseases. There are many ways to improve your heart health; one that I recommend, in addition to exercise and healthy eating, is getting a puppy. Pet ownership is associated with reduction of risk.”

To contact Jefferson Cardiology Associates, visit www.jeffersoncardiology.com or call 412- 469-1500.

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