Change of Heart

How heart disease differs in women and men

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    Nancy Sokoler

We think of heart disease as a man’s issue, but the condition doesn’t discriminate. One in every three American men has some form of heart disease. So does one in every three American women. Heart disease is the top killer for both genders.

But heart disease is not the same for women and men. Women tend to get heart disease later than men and experience different symptoms. And women’s heart attacks are more deadly. 

A woman who has a heart attack before age 50 is twice as likely to die from it as a man. Among those over age 65, women are more likely than men to die within the first year following a heart attack. Torrance cardiologist Victoria Shin, MD, says women’s poorer survival rates stem from the difference in how women and men receive heart attack treatment. 

“Trials and registry studies suggest women with heart disease are treated less aggressively than men are,” she says. “Because women’s symptoms differ from men’s, they aren’t diagnosed as quickly. And once they are diagnosed, it takes longer for them to receive medication.” 

Yet successful treatment depends on prompt delivery. A heart attack prevents blood flow to the heart tissue. The quicker medications can be administered to restore blood flow, the less heart tissue will die. Treatments to open clogged arteries work best when given within the first hour after a heart attack starts.

“It’s not that the medical profession is innately sexist,” Dr. Shin says about the discrepancy in treatment. “Women aren’t as accurately and promptly diagnosed and treated because they have different physiology, different risk factors and different symptoms. More research that includes women needs to be pursued in the cardiology community.”

Dr. Shin is referring to the fact that heart disease treatment stems from medical research on men. Even today, women make up less than one-fourth of the subjects in heart-related studies.

Symptoms: His Versus Hers

Women and men don’t necessarily have the same symptoms for heart disease and heart attacks. According to the National Heart, Lung, and Blood Institute, men tend to feel a pressure or squeezing in the chest, which may extend into their arms. 

Women might have this sensation but might experience sharp, burning chest pain instead. They may have pain in the neck, jaw, throat, stomach or back. 

Both women and men may experience shortness of breath and break out in a cold sweat. But women are twice as likely as men to experience nausea, vomiting or indigestion during their heart attack. And some women don’t experience any symptoms at all.

Lowering Risk

For both genders, heart disease risk increases with age and family history of heart disease. And both men and women can mitigate some of the major factors that put them at risk. According to the American Heart Association, 80% of heart disease can be prevented through lifestyle changes like eating a healthy diet, getting regular exercise and not smoking.

Women, in particular, benefit from maintaining a healthy weight. “The impact of obesity on the development of heart disease appears to be greater in women,” says Dr. Shin, noting a major study showing that obesity increased the relative risk of heart disease by 64% in women, as opposed to 46% in men.

Women with certain health conditions such as high blood pressure or diabetes during pregnancy, rheumatoid arthritis, lupus and certain breast cancer therapies also have a higher risk.

“We need to be more aggressive about screening women for heart disease and checking their risk factors,” says Dr. Shin. “At the same time, women need to be more aware of their risk factors and of the fact that heart disease is more prevalent than they realize.”

That’s advice best taken to heart.