Heart disease runs on both sides of my family. My maternal grandfather died of it at only 58 years of age, in 1958. In that year, cardiovascular disease was the leading cause of death in the United States. More recently, in 2009, my father died of it. Tragically, in the years since my grandfather’s and father’s deaths, heart disease remains a leading cause of death.
Heart disease is known as the “silent killer” because two of the most important risk factors for it—high blood pressure and high cholesterol—have no symptoms, even when they are dangerously high. For this reason, it is very important to get these conditions checked on a regular basis.
There are, however, other heart disease symptoms that are not so silent, and these are the ones that are markedly different in men and women.
Even though the status of heart disease has not changed as the nation’s leading cause of death since the 1950s, one very important aspect of it has recently started to change: physicians’ realization of the critical role that gender plays in effectively diagnosing and treating this dreaded, but highly preventable, chronic disease.
Each year more American women die of heart disease than of all types of cancers combined. And, since the 1980s, more women than men have died from heart disease. Yet many women don’t even realize they are at risk. Many continue to believe that heart disease is something that happens primarily to men. This misunderstanding can be attributed, in part, to the long-standing inability to recognize the less obvious signs of heart disease in women.
There is more to learn, and a need for women to be represented in clinical trials related to heart disease, but there is already enough known about gender differences to save lives now.
Here is the potentially lifesaving information you need to know:
1. Women have unique heart attack risk factors.
The major risk factors for heart disease are the same for men and women, including smoking, obesity, high cholesterol, diabetes, high blood pressure, an inactive lifestyle, loss of hormones, and family history.
However, women have some unique risk factors, including the following:
* Menopause
During menopause, women experience an extreme decrease in estrogen, a hormone that has a protective effect on the heart. Estrogen decreases internal inflammation and releases nitric oxide, which relaxes blood vessel walls and decreases blood pressure.
After menopause, women also develop an increased risk of type 2 diabetes and metabolic syndrome (a cluster of conditions including high blood pressure, abnormal cholesterol, and impaired sugar metabolism)—which increases the risk for heart disease.
* Pregnancy-related conditions
Women are at greater risk of heart attack if during pregnancy they develop gestational hypertension, gestational diabetes, or abnormal prenatal development of the fetus.
* Endometriosis
In this painful disorder, tissue similar to what normally lines the inside of the uterus grows outside the uterus. Endometriosis has been found to raise the risk of coronary heart disease by 400 percent in women under age 40.
* Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a condition in which a woman has increased levels of male hormones (androgens). Just as in men, male hormones appear to be a risk factor for heart disease.
2. Coronary artery disease in women can sometimes be hard to diagnose.
The cardiac catheterization procedure that produces a moving X-ray of the heart and its blockages is the gold standard for finding narrowed passages or blockages in the heart’s largest arteries. But coronary artery disease (CAD) often affects the small arteries, and blockages in these tiny arteries cannot be clearly seen on an angiogram X-ray film. This presents a problem because many women have blockages in these tiniest of blood vessels. The blood vessel might appear to be clean, and a woman can mistakenly be sent home on that basis, only to later suffer a heart attack. This is why any woman who is given the “all clear” after an angiogram but continues to have symptoms should see a cardiologist who specializes in women with heart disease.
Men tend to experience “classic,” obvious symptoms of a heart attack. These symptoms commonly include:
* sudden onset of attack
* extreme chest pain that radiates to the left shoulder and arm
* shortness of breath
* sweating
About 80 percent of women who have a heart attack experience the classic symptoms, as listed above. But for 20 percent of women, heart attacks look completely different. These less common symptoms are just as real, and just as serious, and may include one or more of the following:
* gradual onset over a number of hours or days
* indigestion (a burning feeling in the chest)
* sweating
* dizziness or light-headedness
* fainting
* nausea
* feeling of fullness in the throat
* atypical pain that radiates to the back, neck, or jaw, instead of the chest or left shoulder or arm (Women who have heart attacks report much less chest pain than men do.)
A woman having a heart attack without the classic symptoms will wait much longer to go to the emergency room than a man having heart attack symptoms. And the chances she will be sent home without being correctly diagnosed are two to four times higher than that of a man experiencing chest pain. Because immediate medical intervention is critical prior to and during a heart attack, a delay in diagnosis can be fatal. Therefore, it is crucial that a woman knows these less obvious signs of a heart attack so she can be persistent in seeking care, even if the symptoms aren’t taken seriously at first.
4. The physical impact of a heart attack can be greater for women than men.
Women don’t tend to fare as well as men after a heart attack. They often require a longer hospital stay and are more likely to die before leaving the hospital. This may be, in part, because women who suffer a heart attack have more untreated risk factors, such as diabetes or high blood pressure.
5. Women do not always get the proper medications after a heart attack.
After a heart attack, women are at greater risk of a blood clot that can cause another heart attack. For unknown reasons, they are not as likely to be given a drug to prevent such blood clots. One possible explanation may be physician bias. Many physicians tend to be more aggressive in their cardiac treatment of males, as many still see heart disease as largely a man’s disease. This could explain why women are more likely than men to have a second heart attack within 12 months of the first one.
Based in Frederick, Maryland, Terry Leitma, MA, ABD, is an adjunct instructor passionate about health and psychology. Her doctoral work is in health education.
