Even today, in our modern society, gender differences
continue to be debated. The arguments have generated books,
videotapes and television news shows.
In many ways, the similarities between men and women
outnumber the differences. Yet understanding that men and
women are not identical—physically or psychologically—is
critical, especially when it comes to preventing disease and
promoting good health.
It’s not just a man’s disease
True or false: Cancer is the number one health risk for
You might be surprised at the answer. Most women are.
Heart disease is the number one killer of both men and
women across the nation.
For years, however, experts believed that heart disease was
not a real problem for women. It seemed primarily to affect
men and often presented itself during mid-life. Contrary to that
idea, clear and compelling information from the last decade has
indicated that more women died from heart disease than men.
“The course of heart disease is the same in men and
women,” says Nick Cavros, M.D., a cardiologist with
Pinehurst Cardiology Consultants. “The process of the
disease does not change, but it often presents very differently.
It is rare to have women describe the classic symptoms that
are typical for male heart patients. If I see a female patient
with risk factors for the disease who describes herself as just
not feeling quite right, I immediately take steps to rule out
acute heart problems.”
The traditional warning signs of heart disease include chest
pain or shortness of breath after physical activity or exertion,
intense crushing pressure in the chest or pain that radiates down
the right arm. These symptoms, while present in nearly all men
with heart disease, are often not noticed in women suffering
from the same health problems.
“Women have more vague symptoms that can easily be
overlooked or attributed to some other cause,” says Srivani
Armbati, M.D., a cardiologist with Pinehurst Medical Clinic.
“They may complain of an unusual weakness or fatigue, nausea, dizziness, cold
sweats or sharp pain in unusual locations such as the back, shoulders, arm, neck
or abdomen. The symptoms are not necessarily in response to exertion and may
actually occur at rest.”
Unfortunately, these symptoms are also common during menopause—
which is also when women’s risk increases—as well as among many diseases,
including the flu.
No reason for the difference in men and women has
been scientifically proven, but some studies focus on the
perception of pain as associated with neurotransmission and
Nick Cavros, M.D.
Srivani Armbati, M.D.
John Krahnert, M.D.
Treatment and outcomes
Treatment for cardiovascular disease may include
medication, angioplasty, stents, coronary bypass or some
“There are no differences in the way I manage male and
female heart patients,” Dr. Cavros says. “It is essential to be
equally aggressive in treating the disease once it has been
According to Dr. Ambati, however, “More women tend to
die of a first heart attack than men. They also develop heart
failure due to unrecoverable heart damage at a greater rate
than their male counterparts.”
Why? The answer is simple. At the time of diagnosis,
women are often older and have more widely scattered
disease than men. As a result, their treatments may be less
aggressive but carry greater risk.
“When we are able to recognize heart disease early, we
can treat it more aggressively with better outcomes,” says
In fact, statistics prove that fewer women are referred for
invasive procedures even after an accurate diagnosis. If a
woman is diagnosed at a later age, she may have other health
conditions that rule out surgery. On the other hand, because
men’s disease is usually discovered earlier, it is more likely to
be effectively managed with stent or balloon procedures.
“Differences in treatment and outcomes may not be
simply related to gender,” says John Krahnert, M.D, a
cardiothoracic surgeon with Pinehurst Surgical. “Typically,
women are smaller than men. Their blood vessels are also smaller. Generally
speaking, that makes surgical treatment much more challenging.”
It has been said that the best way to predict the future is to create it. The same
is true with managing cardiovascular disease. Heart disease is largely preventable.
Stopping tobacco use, maintaining a healthy weight, and managing chronic
health problems such as high blood pressure and diabetes are simple steps that
significantly reduce risk.
Establishing a relationship with a health care provider or group also offers
advantages for both men and women. Aside from the trust and reassurance that
such a connection offers, there is also clinical value in monitoring health over
“Knowing a person’s history is beneficial as physicians work to diagnose and
treat disease,” says Dr. Cavros. “Most of my patients come as referrals from family
physicians. The best outcomes are often a result of knowing your own body,
becoming aware of the warning signs and staying in close contact with a primary
care provider, especially when something doesn’t seem quite right.”
“I would get out of my car and
walk across the parking lot to work
like I always had, but the pain in my
chest increased with every step,”
says Gilbert Rall, 55, of Harnett
County. “I tried to convince myself
that it was just bad heartburn, but I
was sure that there was something
wrong with my heart.”
Rall works in Environmental
Services at FirstHealth and is an
active volunteer firefighter. “I am
no Charles Atlas,” he laughs, “but
I’ve always been active and healthy.
When I started to slow down
because of the pain, I knew it was
time to get checked out.”
Rall wasted no time in making
an appointment with a local
cardiologist who determined that
he had one artery with a 60 percent
blockage and another that was
“I have a lot to live for,” says Rall.
“I have a wonderful wife, and a 6-
year-old granddaughter. Agreeing
to bypass surgery was an easy
Rall had a double bypass on June 19. Just
four days later, he was back at home. Just three
weeks later, he was ready to resume his usual
“I’ve never had any surgery before so I was a
little nervous, but I feel better already,” he says.
“I get out and walk, and I am looking forward to
getting back to work.”
Through the surgery, Rall found out something
unexpected. “Apparently, I had a heart attack
without knowing it about five or six years ago,”
he says. “My system actually grew its own bypass
to accommodate the fully blocked artery.”
What has Rall learned from his experience?
“It can happen to anyone,” he says. “I get
regular check-ups. I stay on top of my blood
pressure and cholesterol. My stress tests have
always been clear. This came on suddenly, but if
I had listened to my body a little sooner, I might
have avoided surgery. If you have any pain, even
if it doesn’t seem like much, get it checked out.
That’s the best advice I can give.”
“It’s hard to say exactly when I started having problems with
my heart,” says Elizabeth Wild, 64, of Southern Pines. “It was
probably a while ago, but it was always masked as something
else. At first, I thought I had strained my back. Later, I assumed
it was stress. It never crossed my mind that my symptoms could
be heart related, never in a hundred years.”
Wild, a native of Canada, relocated to the Sandhills in
2005 after spending several years in Florida. Although she
acknowledges that she should exercise more, she has always
felt healthy and leads a relatively active life. In fact, she had
been looking forward to a cross-country vacation ending with
an Alaskan cruise this spring. Instead, she booked a round-trip
ticket to a Moore Regional Hospital operating room.
“I was a walking time bomb, and I didn’t even know it,” she says.
Wild had been tired and depressed. When her mother had
a stroke in December 2006, she immediately left for Canada.
Unfortunately, her mother passed away while she was en route.
“I had been having pain in my back,” she says. “Sometimes it
radiated from my abdomen. In the airport, I was short of breath
walking from one concourse to another.”
When her sister was visiting in March, Wild learned just
how sick she really was. “I was stripping a bed, and I became
breathless,” she says. “I had to cough just to try to catch my
breath. My sister is a nurse, and when she saw what was
happening, she told me I needed to get medical attention right
Wild was admitted to the hospital for a catheterization. David
Cowherd, M.D., a cardiologist with Pinehurst Medical Clinic,
determined that she needed six bypasses, and John Krahnert,
M.D., a cardiothoracic surgeon with Pinehurst Surgical,
performed the surgery on March 19.
One artery was 75 percent blocked, four were 90 percent
blocked, and one was completely blocked.
Wild started to feel better immediately afterward.
“No one would think that I had ever had such a serious
surgery,” she says. “I feel great. I am involved in (cardiac) rehab,
and it’s like being a new person.”
Looking back, Wild admits that she should have sought help
sooner. “I have a family history of heart disease,” she says.
“My father died at 39 and my brother at 37. All of my paternal
uncles died before they reached their 50s. My oldest sister has
stents, and another sister had a valve replacement and bypass.”
What has she learned from her experience? “Don’t poopoo
pain,” she says. “Especially for women, the symptoms for
heart disease can be attributed to other things. Know what the
warning signs are and pay attention to your body. I waited too
long. I was lucky, but I know that it could easily have gone the