Carrie Fisher died early Tuesday morning, four days after suffering a heart attack on a flight from London to Los Angeles. The actress and author, best known for her iconic role as Princess Leia in the “Star Wars” franchise, was 60 years old.
Experts say that Fisher’s death highlights an important reality about heart disease: It is the leading cause of death among men and women alike in the U.S.
While heart disease encompasses many different conditions, a heart attack occurs when coronary arteries become blocked and oxygenated blood can’t reach the heart. About 735,000 Americans have heart attacks every year, but the signs and risk factors that preface a heart attack can be different for men and women.
General risk factors for heart disease include diabetes, lack of exercise and smoking. But additional clues can help tip women off to their risk, said Dr. Nieca Goldberg, a cardiologist and medical director of the women’s heart program at New York University’s Langone Medical Center.
“Most people are familiar with a pretty typical ‘Hollywood’ type of heart attack, where somebody’s clutching their chest and the pain rolls down their arm or up the neck,” Goldberg said. “And while women may have that classic symptom, many times women have symptoms that don’t scream out ‘heart attack.’”
The best way to prevent cardiac-related deaths is for women to understand their own personal risk factors and be able to recognize the signs of a heart attack, which may be different from a man’s experience.
How heart attacks are different for women
Women may describe their heart attack signs as “flu-like,” with nausea, dizziness, weakness, shortness of breath, fatigue and back pain. While they might feel pain in their torso, it could be off-center or lower down, where it can be mistaken for a stomach issue, Goldberg said.
Women’s heart attack symptoms can be different from men’s because the condition tends to be more diverse in women, says Dr. Jennifer Mieres, a professor of cardiology at the Hofstra Northwell School of Medicine and a spokeswoman for the American Heart Association.
For instance, men are more likely to have an obstruction in their arteries, while in women coronary heart disease is caused by a wide spectrum of issues, including non-obstructive coronary artery disease (a condition where the arteries are not blocked but still don’t transport blood efficiently) or atherosclerosis, which is when the arteries harden and narrow.
Women are likely to put off seeking care for longer than men. One study found that it took a median of 54 hours for the average woman to see a doctor after signs of a heart attack, while men took about 16 hours. Men are also more likely to have heart attacks at an earlier age and survive them, while women are more likely to have heart attacks later on in life, and to die as a result.
Women who are at high risk of heart disease need to learn the more diverse ways that a heart attack can present itself, said Goldberg, so that they don’t waste any time in seeking medical care. In Goldberg’s own practice, she’s seen her female patients sometimes delay calling 911 because they want to spend time looking up symptoms on the web.
Goldberg also advised people who think they’ve had a heart attack to ride to the hospital in an ambulance, because it contains equipment to treat cardiac arrest, which is when the heart stops beating completely.
“I practice in New York City, and when patients tell me they took a taxi to the hospital, it frightens me,” Goldberg said. “You’ve got to call 911.”
How to assess your own risk factors for heart disease
Women also have risk factors that are distinct from those of men. For example, women who develop pre-eclampsia during pregnancy have more than double the risk of heart disease in their later years, compared to women who don’t experience pre-eclampsia. And while both men and women with autoimmune diseases like lupus or rheumatoid arthritis have a heightened risk of heart disease, these diseases are more common in women.
Of course, most risk factors apply to both genders. High cholesterol, triglyceride levels, blood pressure and blood sugar levels, as well as a greater waist circumference, can all increase one’s risk of heart disease. Smoking, excessive drinking and drug use can also increase one’s risk of heart attack and stroke, because they can result in stiffened aortas, hardened heart tissue, heightened blood pressure and plaque buildup in the arteries.
The holiday season is its own risk factor
Research shows that wintertime and the holiday season are linked to an increase of cardiac episodes like heart attacks. Cold air can restrict blood vessels, which prevents oxygenated blood from reaching the heart. The holiday season can also increase one’s risk for cardiac death, perhaps because people tend to travel during this time and might postpone medical care for symptoms that would normally worry them.
Anyone at risk of heart disease needs to take extra precautions this time of year, especially while traveling, Mieres warned.
“The travel climate or the travel milieu can definitely put a patient with risk factors for heart disease at increased risk,” she said.
Mieres, who did not treat Fisher, says she always counsels patients who have a history of heart disease or heart disease risk factors to take special precautions before going on long flights.
Staying sedentary for a long period of time during a flight raises the risk of blood clots for anyone, but it can be especially dangerous for people with pre-exising plaque in their blood vessels. Travelers can mitigate their risks by getting up frequently while in transit, walking around, doing leg exercises, staying well-hydrated and taking an aspirin before the trip to help their blood stay less viscous and less prone to clotting.
How to recognize the early warning signs of a heart attack
While some heart attacks can come completely unexpected, studies show that some people experience more muted symptoms of a heart attack days or even weeks before the real thing. If you think you’ve experienced aches or mild chest pain, but they passed quickly after rest, it’s best to see a doctor to rule out any underlying disease, Goldberg said.
Doctors can perform stress tests or other imaging studies to see if you have coronary disease or narrowed arteries. If they find a blockage, surgeons can open arteries with a stent placement or coronary artery bypass surgery.
“It’s about preventing that first heart attack,” Goldberg said, “and that’s about taking care of risk factors and recognizing the signs and symptoms.”