In Considering the Heart | Part 1 | Type 1 Diabetes, I addressed my pretense of belonging to the “Not Me” club. As a woman, it is easy to think that I have a similar “Not Me” pass when it comes to heart problems because isn’t heart disease a man’s disease? Based on the attention given to breast cancer in this country, shouldn’t cancer be my biggest concern? Wouldn’t I have symptoms if I had cardiovascular disease (CVD)? Won’t I know if I am having a heart attack or a stroke? Although I know that my risk for heart disease has risen because I am in my 60’s, aren’t younger women protected from cardiac problems?
Let’s burst these bubbles right away—
FACT: Heart disease is the leading cause of death for women in the United States. About 1 of every 3 female deaths is the result of heart disease.
FACT: Every year since 1984, more women than men have died of heart disease in the United States. Alarmingly, women are twice as likely as men to die following a heart attack.
FACT: Heart disease is more deadly than all types of cancer combined. Six times as many women will die of heart disease in the coming year compared to deaths from breast cancer.
FACT: Heart disease may be silent and not diagnosed until a woman has a heart attack or stroke. Almost two-thirds of women who die suddenly from CVD had no previous symptoms.
FACT: Symptoms of heart attacks can be different for women compared to men. Although many women experience the most common symptom of chest pain, about 40% 
of women experiencing a heart attack have no chest symptoms at all. Instead of or in addition to pain, they may have severe fatigue, shortness of breath, indigestion, and anxiety.
FACT: Although heart disease is more common in older women, it is a threat to all women. The incidence of sudden cardiac death for women in their 30’s and 40’s has risen 30% in the last decade.
The above statistics are relevant to all women. Now for a few disturbing facts that pertain to women with Type 1 diabetes.
♥︎♥︎♥︎ Although rates of CVD in the general population are lower for premenopausal women than for men, this female sex protection is not seen for women with Type 1 diabetes. At all ages women with T1DM are more likely to have a CVD event than healthy women.
♥︎♥︎♥︎ According to one large meta-analysis of sex-specific mortality from 1966-2014, women with Type 1 diabetes were found to have nearly twice the risk of dying from heart disease compared to men with T1 and a 37% increased risk of stroke.
♥︎♥︎♥︎ CVD risk factors are more common in children with T1DM than for the general population and even at a young age, girls with Type 1 have a higher risk burden than boys with T1DM.
In the past and even currently, the incidence of heart disease in women has been under-estimated. I follow an excellent blog about women and CVD disease titled Heart Sisters. Patient Advocate Carolyn Thomas launched the blog in 2009 to provide current and relevant CVD information to all women. She had previously suffered a heart attack with a 99% blocked coronary artery two weeks after being sent home from the ER with a diagnosis of acid reflux. A startling statistic in her About Me page says it all:
“According to research published in the New England Journal of Medicine, women my age and younger are seven times more likely to be misdiagnosed in mid-heart attack and sent home from Emergency compared to our male counterparts presenting with identical symptoms.”
There is hope that the diagnosis/care gap for women with heart disease is being addressed as evidenced by a January 2016 AHA Scientific Statement titled “Acute Myocardial Infarction in Women.” This paper received broad coverage by mainstream media, including this report on CBS News. The most powerful statement in the CBS video is by NYC cardiologist Dr. Holly Andersen: “Heart disease in women is under-researched, under-diagnosed and under-treated.”
Most of us with Type 1 diabetes have learned the value of education and how to advocate for ourselves. As women, particularly women with Type 1 diabetes, we need to do the same in regards to our cardiovascular health. A lot of the information in this post seems to be gloom and doom. In general I prefer to be an optimist and view it as a wake-up call to intensify my efforts to address my controllable risks for cardiovascular disease. Because CVD is highlighted in the ADA Standards of Medical Care in Diabetes—2016, those of us with diabetes may have a head start on other women in having these conversations with our doctors. Below you will find some links to launch your education on women and cardiovascular disease.
In the concluding section of this 3-part series on CVD, I will share my experiences and thoughts on my cardiovascular risks as a woman with diabetes. There is no doubt that although I follow most of my doctors’ recommendations, I have often dismissed these risks in the past. It is a difficult post to write because like all of you, I am dealing with statistics and probabilities along with no black-and-white answers or guaranteed outcomes. For the most part, I just don’t know.
Please remember that I am not a medical professional. Although this blogpost presents a lot of information about women and cardiovascular disease, it is by no means complete. Do your homework and talk to your medical professionals about your risks.
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*** Relevant Links for Women & CVD Disease ***
AHA statement on women and heart disease January 2016
American Heart Association Go Red for Women
Am I Having a Heart Attack? | Heart Sisters
Heart Disease Statistics | The Heart Foundation
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*** Relevant Links for Women with Type 1 Diabetes & CVD Disease ***
ADA Women, Coronary Heart Disease and Diabetes
How Diabetes Differs for Men and Women, Diabetes Forecast, Oct., 2011
Women with Type 1 Diabetes “Twice as Likely” as Men to Die from Heart Disease
*** Related Posts ***
Test Guess and Go 
It is an easy sale for me to care about women’s heart health. Once again your post makes the case better than anything I can say. At our house (after a blockage or two and open heart surgery) we understand heart health.
I referred this blog to the TUDiabetes blog page for the week of April 12, 2016
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