A conversation with the pioneering researcher and namesake of the American Heart Association’s Jean C. McSweeney, Ph.D., RN, Women in Medicine Award.
Your research helped establish that women’s heart attack symptoms can differ from the symptoms many people traditionally associate with a heart attack. What did you learn from listening to women’s experiences, and what do you most want women to understand about those warning signs?
A very important thing I learned from the multitude of women who participated in my research studies is that women usually sense when something is wrong, but often delay seeing a healthcare professional for a variety of reasons such as being a caregiver, can’t take time off from work or childcare responsibilities. Most women have at least one or more early warning symptoms that are new or different. They need to pay attention to their body and seek medical advice when these symptoms persist.
You developed the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey to examine symptoms that can occur before a heart attack. What are “prodromal” symptoms, and why is it so important women not dismiss changes in how they feel simply because they aren’t experiencing dramatic chest pain?
Prodromal symptoms are early warning symptoms that are new or change in intensity and/or frequency and may occur weeks before a cardiac event. If women pay attention to their bodies, they may detect these symptoms and seek appropriate help, which may prevent or delay experiencing a heart event such as a heart attack. Many women do not experience chest pain until they are having a heart attack. The most common prodromal symptom women in my studies reported was unusual unexplainable fatigue that persisted day after day. Other frequently reported early warning symptoms were shortness of breath and sleep disturbance.
Heart disease is still widely misunderstood as primarily a man’s disease. Why has that perception been so persistent, and how has it affected women’s willingness to seek care as well as clinicians’ ability to recognize risk and diagnose disease?
Unfortunately, early research found that men were more likely to have heart attacks than women, and this is typically true at younger ages. What is more dramatic than a man clutching his heart and falling over dead? Hollywood has done an excellent job of incorporating this picture into our minds. This mental picture persists today. However, as women approach menopause, they begin to have more heart disease including heart attacks, but their symptoms may be more subtle and not dramatic enough to portray in the movies. Women may not seek medical care because they have this same mental picture — stabbing chest pain — because they are experiencing less dramatic symptoms and will rationalize and minimize their symptoms.
Research findings provide the basis for clinicians’ diagnosis and treatment of heart disease. For many years, and unfortunately continuing today, men far outnumber women in research studies. This means we know much more about diagnosing and treating men with heart disease than we know about women.
From your perspective as both a nurse researcher and longtime heart health advocate, what are the most important risk factors Arkansas women should be talking about with their healthcare providers, especially factors such as blood pressure, cholesterol, diabetes, smoking, family history, physical inactivity and stress?
Your list of risk factors is very good. Women should definitely know all their numbers such as blood pressure, cholesterol (good HDL, bad LDL and total number), and family history. Keep track of these numbers so they can compare progress with each appointment. Remember that up to 80% of heart disease may be preventable, so knowing these numbers is vital to prevention. Family history and age are not modifiable risk factors, but all the other risk factors are modifiable. This is great news. Two other risk factors are being diabetic and being overweight. Maintaining blood sugar control and achieving a healthy weight will also help prevent heart disease. Women should discuss how to best manage their risk factors with their healthcare provider.
Women are often balancing careers, caregiving, families and community responsibilities. What practical, realistic steps can a busy woman take now to make heart health part of her everyday life rather than another overwhelming item on her to-do list?
Increasing physical activity provides many dividends. It will help to decrease stress, lower blood pressure and help with weight management. Taking the stairs, going for a 10 minute walk at lunch or walking with a partner or with the entire family in the afternoon/evening is a heart healthy way to decrease your risk profile, enjoy the outdoors and spend quality time together. Quit looking for that closest parking space when getting groceries and instead add steps to your day. Choose to move.
You have worked closely with the American Heart Association at the local and national levels, including chairing an AHA scientific statement focused on ischemic heart disease in women. What role has the AHA played in changing the conversation around women’s cardiovascular health, and where is more progress still urgently needed?
The American Heart Association is vitally important in promoting heart health in women. It funded one of my earliest studies that included only women — a rarity at the time. In fact, the association funds more heart research than any other organization after the National Institute of Health Heart, Lung and Blood Institute. It is instrumental in the Go Red movement to increase recognition of heart disease in women and to educate both women and clinicians about heart disease in women. It actively encourages women to participate in research studies. We cannot develop the best treatments if we do not have enough women in studies to see which treatments are most effective. In fact, the association has launched a new program, Research Goes Red, which is trying to recruit 1 million women to participate in a national long-term study where women will be contacted over a period of time. Women of all ages and backgrounds are needed so we can learn to help all women. I highly encourage women to support this effort.
Can you describe a symptom pattern women commonly explain away?
The most common early warning symptom in every study I have conducted is unusual unexplained fatigue. Women go to bed tired, they wake up tired and it can be so severe it interferes with activities of daily living. This is different from normal fatigue where you know what causes it. It is new and gradually worsens. Women tend to ignore it, minimize or discount it. Some rationalize it as anxiety or stress, but upon questioning, their anxiety or stress levels have not changed, just the fatigue is new and unexplained. This new unexplained fatigue in women with known cardiac risk factors is reason to see a healthcare provider.
Lightning Round
What is one phrase you wish every woman would say to herself before deciding not to seek medical help? What would my loved ones do without me?
What has changed most in the medical community since your early research? More recognition of heart disease as the number one killer of women, which impacts treatment.
What can employers and women’s leadership organizations do to make prevention easier? Offer healthy foods, accessible inside or outside walking trails for lunch breaks, self-help groups for weight control, smoking cessation, etc. and free blood pressure screenings.
For event information and to read more about Go Red for Women, visit heart.org/centralargored.