It’s Not a Man’s World: What We All Should Know About Heart Disease in Women

Katharine French, MD

Historically, heart disease has been thought of as a man’s disease. We now know that this is wrong. These are the facts:

  • One out of every three female deaths each year is caused by heart disease or stroke.
  • Women are more likely to suffer a stroke in their lifetime compared to men.
  • Cardiovascular disease is currently the leading cause of death in African-American and Hispanic women.
  • All women are at increased risk of developing heart disease as they age.

The aging heart

Coronary artery disease, or atherosclerosis, is the most common form of cardiovascular disease affecting women. It is a buildup of plaque in the arteries, which can result in heart attacks and strokes. Coronary heart disease can affect women at any age, though it is more common in older women who have gone through menopause. Younger women who are affected are more likely to:

  • have a strong family history of early heart disease
  • smoke
  • lead a sedentary lifestyle

Post-menopausal women are at increased risk of heart disease compared to premenopausal women, primarily because they are older. Hormones such as estrogen and progesterone, which decrease after menopause, may play a role in cardiovascular health. However, taking hormone replacement therapy (HRT) after menopause has not been shown to decrease the risk of developing heart disease. In some women, HRT has actually been shown to increase the risk of heart as well as other diseases, such as breast cancer. For these reasons, HRT is not recommended for the prevention of heart disease and women who have heart disease, or are at high-risk for developing heart disease, should generally avoid HRT.

The differences between men and women

A startling reality is that women are more likely to die from their first heart attack than men. How is this possible when we are talking about the same disease? There are likely many explanations, including both physiologic and cultural differences.

Men have been shown to have more “typical” symptoms of a heart attack which include:

  • central or left-sided chest pressure or pain
  • shortness of breath
  • nausea and/or vomiting
  • profuse sweating

While women can also have these classic symptoms, they are more likely than men to present with “atypical” symptoms. Those include:

  • shortness of breath without pain
  • dizziness or lightheadedness
  • extreme fatigue
  • pain in the jaw, back, lower chest, or upper abdomen

Because these “atypical” symptoms are not only linked to heart attacks, it can result in a delay in the woman seeking treatment, as well as a delay in the correct diagnosis. Once the diagnosis is made, studies have also found that women being treated for a heart attack are less likely to be referred for invasive, often times life-saving treatment (heart catheterization) when compared to their male counterparts.

Prevention can work for all

Despite the many differences in cardiovascular disease in men and women, old and young, preventative strategies are similar for all.

Here are five things that anyone can do that will reduce the risk of heart attack and stroke at any age:

  1. Get moving. Regular exercise is a key part of preventing heart disease. Aim for 30 minutes of moderate exercise most days of the week. “Exercise” can be as simple as walking. In addition to improving cardiovascular health, regular exercise helps with weight control, bone health, anxiety, and depression. If other health conditions limit your ability to walk, an inexpensive gym membership provides a range of options that should be able to accommodate most physical limitations. Remember, any exercise is better than none!
  2. Stop smoking. Smoking is one of the leading causes of heart disease, increasing your risk of heart attack or stroke two to four times. Quitting smoking reduces that risk, whether you have been smoking for five or 50 years. Smoking even one cigarette a day puts you at increased risk for heart disease. So while cutting back on smoking is a start, quitting completely should be your goal.
  3. Eat healthy. A balanced diet that includes plenty of vegetables, fish, fiber-rich whole grains, and healthy fats (nuts, olive oil) has been shown to decrease the risk of heart disease. Foods to avoid include items that are high in sugar, refined carbohydrates, saturated fats, and red meat. In general, a plant-based diet, in addition to fish, is recommended for heart health.
  4. See your doctor regularly. Health conditions that increase your risk for the development or worsening of heart disease include high blood pressure, high cholesterol, and diabetes. These are chronic diseases that, with the help of your doctor, can be effectively managed to decrease your risk of heart disease.
  5. Know the signs. Being familiar with the signs of a heart attack or stroke will increase the chance of seeking medical care in a timely manner, which can lead to better outcomes.

If you have questions about women and heart disease, visit our website for more information.

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