Jane Nelson Worel, MS, ANP-BC, APNP, FPCNA, FAHA, is passionate about raising awareness of the key role nurses play in cardiovascular risk reduction. She has been a member of the Preventive Cardiovascular Nurses Association board of directors since 2004 and served as its president in 2009.
An adult nurse practitioner with more than 15 years of experience in preventive cardiology, Worel practices at Phases Primary Health Care for Women in Madison, Wis.
Voted one of Madisons favorite nurses, this fellow of the American Heart Association talked to Nurse.com about the publics perception that heart disease is largely a problem for men, how heart attack symptoms differ in women and ways women can reduce their risk.
Q: So many people equate heart attacks with men. Why does this misconception continue?
A: It is getting better, there has been a lot more awareness in the last decade or so … with the Red Dress Campaign and the Go Red for Women Campaign, which are dedicated to trying to help the general public as well as healthcare providers remember that heart disease is still the No. 1 cause of death in women. That misconception exists because it generally happens in women at an older age [compared] to men who are in their 40s or 50s, and we are all shocked when a person dies suddenly. But for women, [heart disease] is more prevalent in their 70s and 80s. People say, OK, we expect people to die in their 70s and 80s. Its not a rare thing. We may not see the classic sort of Hollywood heart attack as often where women are clutching their chest and dropping dead. Its a little bit more subtle presentation, and it occurs in older women.
Q: What are the heart attack symptoms in women?
A: Women do get chest pressure or that squeezing or tightness in the chest similar to men, but womens heart disease symptoms can also be more subtle. They may feel short of breath or nauseated or fatigued … which can be blamed on so many other things that we dont always hone in on heart disease. [Still] the chest pressure, the pain radiating down the arm and up to the jaw or neck area or down the back, all of that can happen in women similar to men.
Q: What percentage of women have risk factors for heart disease?
A: More than 75% of women ages 40 to 60 have one or more risk factors, which include obesity, high blood pressure and cholesterol disorders.
Q: What can women do to reduce their risk of heart disease?
A: Women need to know their family history and identify their risk factors. They really need to start early on in life to follow a healthy lifestyle … to reduce risks. Eat a heart-healthy diet. We consider the Mediterranean diet as the way to go to prevent heart disease. Get regular exercise, which is typically defined as about 30-40 minutes of exercise most days of the week where you get your heart rate up. Not smoking. And talking with their healthcare provider about the use of hormones or oral contraceptives as well as postmenopausal hormone replacement, and whether thats a safe application of hormones. But the lifestyle is the foundation. Maintaining a healthy weight certainly helps to lower the risk.
Q: Is heart disease something only older women should worry about?
A: No, I think even young women in their late teens and 20s should be aware of their risk factors. Young women are the biggest age group of smokers in this country, and we want women to make that connection to never start because once you start that increases your risk of heart disease precipitously. Heart disease starts when we are young in terms of plaque in the arteries and that just gradually builds up over time. Reduce risk by starting young to follow a healthier lifestyle. Work with health providers to know what your numbers are for blood pressure and cholesterol. Work to really manage those things with lifestyle as well as medications if needed to prevent heart attacks and strokes.
Also, there has been more awareness created about when women have high blood pressure and high blood sugars during pregnancy. Thats an important marker of future risk of a heart attack. Those women need to be more attuned to a healthy lifestyle and make sure healthcare providers are asking, Did you have complications during pregnancy? even if that was 10 or 15 years ago because that increases their risk factors.
Q: What are some PCNA initiatives to promote awareness about heart disease in women?
A: We work with healthcare providers to make sure there is an awareness, in particular, of cardiovascular nurses. We have an annual scientific symposium every spring. In April 2015 we will be meeting in Anaheim, Calif., and we have a whole Saturday symposium dedicated to women and heart disease with internationally known speakers. We always had a leader on the writing panel for the American Heart Associations heart disease prevention guidelines for women, and we developed a companion education piece called The Living Guidelines for Heart Disease Prevention. We distribute that among our members as well as any partner organizations to be able to impact women in the community and in our individual clinical practices.