Although heart disease is often thought of as a problem for men, more women than men die of heart disease each year. There are many factors that have made diagnosis and treatment of coronary heart disease (CHD) in women more challenging:
- Most of the research on heart disease has been conducted on men. It’s only within the last decade that we learned that the presentation, manifestation, and diagnosis of heart disease in women is different than men.
- For years, this lack of research as well as gender bias played a role in dismissing symptoms in women as meaningless or fictitious. Some people still believe that heart disease is a “man’s disease.”
- The classic heart attack symptoms: chest pain, tingling down the arm (usually the left arm), accompanied by shortness of breath, profuse sweating, and light-headedness are more common in men. Women often experience less specific symptoms such as pain in the back, neck, jaw or stomach and nausea, indigestion, or vomiting.
- Women wait longer to go to an emergency room, assuming their symptoms are not heart-attack related. This may be one reason why more women than men with a heart attack die before they reach a hospital.
- Health care professionals and patients often attribute chest pain in women to non-cardiac causes.
- Women tend to have heart attacks later in life when they have other diseases which can mask heart attack symptoms. Increased age explains why women have greater mortality after a heart attack.
- Men’s plaque distributes in clumps whereas women’s distributes more evenly throughout artery walls. This results in angiographic tests being misinterpreted as normal.
While men and women share the traditional risk factors for heart disease—high cholesterol, high blood pressure and obesity—other factors affect women to a greater extent than men.
- Metabolic syndrome — a combination of fat around the abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than on men.
- Mental stress and depression affect women's hearts more than men's. Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment.
- Smoking is a greater risk factor for heart disease in women than in men.
- Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels.
The ongoing National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study has helped explain why detecting heart disease in women is more challenging. Researchers believe that as many as half of the women with heart disease have Coronary Microvascular Disease (MVD) that may go undiagnosed. With MVD plaque accumulates in very small arteries of the heart, causing narrowing, reduced oxygen flow to the heart, and pain that can be similar to that of people with blocked arteries, but the plaque does not show up when physicians use standard tests. When a diagnosis of this condition is missed, women are not treated for their chest pain and high cholesterol and they remain at high risk for having a heart attack. These are the women who, in the past, may have been told that the problem is “all in their head.”
Standard treatments for coronary blockage, such as angioplasty, stenting and bypass surgery, are not an option to treat MVD. Instead, the treatment focuses on reducing risk through managing high blood pressure, diabetes and high cholesterol. Exercising, maintaining a healthy weight and not smoking are also important.
The message for women is to learn the risk factors and symptoms of heart disease specific to women. Many women tend to show up in emergency rooms after much heart damage has already been done because their symptoms are not those typically associated with a heart attack. If you experience any of the symptoms listed above or think you're having a heart attack, call for emergency medical help immediately. Don't drive yourself to the emergency room unless you have no other options.
Learn more about Heart Disease in Women. Watch the video below:
National Heart Lung and Blood Institute.
National Heart Lung and Blood Institute.
American College of Cardiology.