More than one in three women is living with some form of heart disease. That’s more than all cancers combined. It is also the deadliest disease for women, causing one in five female death.
As more women are being included in research studies, we are learning more about sex differences in heart disease. We now know there are heart problems that affect only women or predominantly women, there are different presentations of heart problems in men and women, and there are differences in how therapies affect men and women.
Here are eight things women should understand about their heart and their risk for cardiovascular disease.
1. Heart Attacks Can Feel Different For Women
Although the most common presentation of heart attacks is chest discomfort in men and women, it is important to know that women are more likely than men to have atypical symptoms such as shortness of breath, severe fatigue, or nausea.
“This idea is becoming more mainstream, but it’s worth repeating so women don’t ignore these important symptoms especially if they are associated with exertion,” explains Monika Sanghavi, MD.
If you or someone around you ever has these symptoms, don’t brush them off!
- Shortness of breath
- Nausea/vomiting
- Back and jaw pain
- Dizziness, lightheadedness, or fainting
- Lower chest or upper abdomen pain
- Extreme fatigue
2. Microvascular Disease Can Be the Cause of Chest Pain in Women
Although most of the attention has been on the large blood vessels of the heart, the small blood vessels of the heart can also cause problems. It is often overlooked because diagnostic testing requires specialized machines and training.
These small blood vessels, called the microvasculature, can be damaged from hypertension, diabetes, smoking, etc. These blood vessels are responsible for regulating blood flow and when the lining of the vessels are damaged, they are unable to provide adequate blood flow to the heart which can cause chest pain.
Research is underway to find the best ways to treat microvascular dysfunction since most of the current treatment strategies are for the larger heart arteries.
3. Some Heart Attacks Occur Without Significant Blockage
In many cases, a heart attack occurs when the blood flow to the heart becomes blocked by excess plaque buildup in the coronary arteries. However, not all cases occur with significant blockage. MINOCA (myocardial infarction with non-obstructive coronary arteries) is a term used for heart attacks that occur without showing significant blockage on a coronary angiogram, a type of scan that shows the flow of blood through arteries, veins or the heart.
While this type of heart attack is rare, it is also more common in women than men. With additional testing, we are sometimes able to determine the cause of the heart attack but in many it remains a mystery. If you’ve had this type of heart attack, you’re still at an increased risk of future heart attacks so it’s important to continue to see a cardiologist.
Some causes of MINOCA heart attacks include:
- SCAD: Spontaneous coronary artery dissection
- Coronary Vasospasm
- Myocarditis
- Plaque erosion
- Small clot from another part of the heart
The best treatment for this type of heart attack is still being investigated.
4. Pregnancy Complications Can Be Associated with Increased Risk of Heart Disease
Certain pregnancy complications are associated with an increased risk of heart disease for the future, such as:
- Gestational hypertension
- Preeclampsia
- Gestational diabetes
- Preterm birth (delivery <37 weeks)
- Small for gestational age baby
Women should be aware of this and discuss how to reduce their risk of a heart attack with their doctors.
5. Heart Disease is Preventable
Although heart disease is extremely prevalent, the American Heart Association estimates that 80 percent of heart disease is preventable and has encouraged people to follow Life’s Simple 7 to lead a healthy life:
- Control cholesterol
- Eat better
- Maintain a healthy weight
- Get active
- Manage blood pressure
- Reduce blood sugar
- Stop smoking
In a recent study, a poor diet was linked to almost 50% of death from heart attacks, stroke and diabetes. “I am a strong believer that food is medicine. It is important for everyone to eat a diet full of fresh fruits, vegetable and whole grains and a diet low in processed foods and sugars in order to set themselves toward a path of a healthy heart,” says Dr. Sanghavi.
6. Some Types of Heart Failure Are More Common in Women
Ejection fraction (EF) is a percentage of the total amount of blood that is pumped out of the left ventricle with each heartbeat. An EF below 40 is typically an indicator of heart failure. However, some people experience heart failure with preserved ejection fraction (HFpEF), meaning that their EF is greater than 50 percent. This type of heart failure is more likely to affect women.
Common symptoms include:
- Shortness of breath or chest pain when laying down to sleep at night or with activity
- Swelling in your legs
- Coughing at night when laying down to sleep
- Severe fatigue
- Weight gain despite no change in diet
It is important to discuss these symptoms with your doctor. Treatment often involves treating the factors that can cause the heart to stiffen such as hypertension, obesity, sleep apnea as well as getting rid of extra fluid in the body.
Knowledge is power. Be in the know and be your own self advocate and an advocate for the other women in your life!
7. Women are at Greater Risk After Menopause
Before menopause, estrogen helps protect women from heart disease. This is because estrogen works to increase HDL (“good”) cholesterol and lower LDL (“bad”) cholesterol. After menopause, however, women lose this protection and often have higher total cholesterol than men, which puts them at a greater risk for heart disease.
There’s another reason the post-menopause period is linked with heart disease: elevated triglycerides. Low HDL cholesterol and high triglycerides are two risk factors that have been shown to increase the risk of death from heart disease in women over 65.
8. Many People Don’t Fully Grasp the Risks
First, some good news: the number of women who know that heart disease is their greatest health risk is increasing. In fact, the number doubled in the last 15 years.
But this knowledge still lags, especially among some groups. A 2017 study from the Journal of the American College of Cardiology found that 45 percent of women were unaware that heart disease is the leading cause of death in women. Awareness levels were even lower in women with lower levels of education, income and ethnic minorities. And approximately 71 percent of women did not raise the issues of heart health with their primary care doctor.
This gap can translate into patient care. For instance, women with heart disease have a 50 percent higher chance than men of receiving an inaccurate initial diagnosis, even after having a heart attack. Women also have higher rates of death during hospitalization for a heart attack than men and are 30 percent more likely than men to be misdiagnosed and sent home from the emergency room while having symptoms of a stroke.
“It’s crucial to trust your instincts, keep accurate records, get second opinions when needed,” Dr. Sanghavi says. “And never assume you’re “too young” or “too healthy” to have heart disease.”