A misconception about heart disease is that it’s a “man’s disease.” Nothing could be further from the truth. In fact, one in nine women between the ages of 45 and 64 will develop some form of heart disease. However, women tend to develop cardiovascular disease, on average, a decade later in life than men. Yet, it’s still the most common cause of death in women. In fact, heart disease kills five times more women than breast cancer does.
In some ways, heart disease behaves differently in women than in men. Women don’t always present heart disease in a classic manner and even when they do, women tend to have a poorer outcome. That’s why we need to be aware of differences in how heart disease presents in men and women. Here are some of the differences you should know about.
Females Don’t Necessarily Have “Classic” Heart Attack Symptoms
When you envision someone having a heart attack, you probably picture a man grasping the left side of his chest in pain, breathing rapidly, with sweat rolling down his face. Heart attacks often do present in men in this way. However, women typically have subtler signs and symptoms and often don’t seek medical attention when they first appear. Women, not uncommonly, have atypical chest pain, a vague sense of chest, back, or upper abdominal pressure rather than the crushing chest pain we classically associate with a heart attack – the old elephant sitting on the chest type of pain. Surprisingly, some women don’t experience chest pain at all but have more subtle symptoms, like breathlessness, indigestion, lightheadedness, indigestion, or fatigue. Rather than seeking help, some women ignore it, assuming it’s stress or a viral illness coming on. In one study, 43% of women who were having a heart attack didn’t experience chest pain at all.
Women Have Poorer Outcomes with a Heart Attack than Men
Unfortunately, women have poorer outcomes when they have a heart attack than men. One reason is females frequently seek medical attention later than men as they don’t realize they’re having a heart attack. Unfortunately, health care professionals are biased with regard to women and heart attacks as well. They’re more likely to diagnose chest pain in women, especially those under 40, as something other than heart disease or a heart attack. While it’s not common for a woman under the age of 40 to have a heart attack, risk factors like obesity, smoking, type 2 diabetes, uncontrolled high blood pressure, and a strong family history, magnify the risk. Taking birth control pills, especially if you smoke, also increases the odds of heart attack and stroke.
Based on research, even when women having a heart attack reach the emergency room in time, they are less likely to be treated in an aggressive manner. It comes down to lack of awareness at all levels that women, even young ones, not infrequently, have heart attacks.
Certain Women are at Higher Risk of Heart Attack
Women have twice the risk of developing an autoimmune disease as a man does and some autoimmune disorders increase the risk of heart disease and heart attack. Examples are inflammatory autoimmune disorders such as psoriasis and rheumatoid arthritis. The inflammation associated with autoimmune diseases damage the arterial walls and speed up plaque formation. We now know that inflammation is a promoter of heart disease. Some medications used to treat autoimmune disorders may also increase the risk. If you have an autoimmune disease, talk to your doctor. You’ll want to be followed and screened more aggressively.
If you have a condition called preeclampsia during pregnancy, you’re also at higher risk of a heart attack or stroke later in life. Preeclampsia is a condition where blood pressure rises during pregnancy and you develop protein in your urine. You typically also experience headaches as well as swelling in the hands and feet. Having this condition is linked with double the risk of having a stroke or heart attack later on, sometimes decades later. If you had this condition, you may need to be screened and monitored more closely.
Hormone Replacement Therapy Impacts Heart Disease Risk
Hormone replacement therapy is controversial. There was a strong movement away from it after studies linked estrogen/progesterone combination therapy with a greater risk of breast cancer. Some studies also linked hormone replacement with a higher risk of stroke. However, a more recent study showed that women taking hormone replacement therapy were 30% LESS likely to die from heart disease than those not taking it. They were also more likely to have a favorable calcium score, a measure of plaque build-up in the arterial walls.
In the study, hormone replacement therapy was associated with longer survival as well. Researchers controlled for other risk factors for heart disease in the study and it was a large, well-conducted study, adding credibility to the results. Still, hormone replacement therapy isn’t appropriate for all women. You have to weigh a variety of factors. It’s best to discuss these issues with your physician.
The Bottom Line
As you can see, women get heart disease and have heart attacks, just like men do but usually get them later in life. Plus, the symptoms may be different than what we think of as “typical” heart attack symptoms. Some women may also be at higher risk due to other issues like autoimmune diseases, as well as health issues like diabetes and uncontrolled high blood pressure. Don’t assume because you’re female or still pre-menopausal that your risk of heart disease is low. Take steps to lower your risk with diet, exercise, and by modifying other lifestyle factors such as stress and sleep. No one, regardless of sex, is immune to heart attacks.
American Heart Association. “Heart Attack Symptoms in Women”
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Preeclampsia Foundation. “Pregnancy Complications Strongly Linked to Heart Disease”
American College of Cardiology. “Hormone Replacement Therapy Associated with Lower Mortality”
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