Heart disease is the leading cause of death in both women and men in the U.S., but women are often left out of conversations about heart health. Heart disease and heart attacks have traditionally been thought of as a disease of men and the typical symptoms of a heart attack are, as a result, mostly the ones men experience. But in recent years the medical community has started to realize that this male bias may be doing a serious disservice to women. For the first time in its history, the American Heart Association (AHA) has released a scientific statement on heart attacks in women to bring together what we know about heart disease in women and how the medical community can move forward in preventing this deadly illness.
How serious is the problem of heart disease in women?
While heart disease was typically thought to be a man’s disease, a hard look at the numbers shows the opposite to be true. According to the AHA’s statement, more women die every year from heart disease than men, and it’s been that way since 1984. If you look at the total number of people living with heart disease in the U.S. and dying from its complications, women also unfortunately come out over men. While new treatments have both helped to stop the development of heart disease and avoid some of its complications, heart attacks still kill more than 53,000 women every year and put another 262,000 in the hospital.
How are heart attacks different between men and women?
Heart attacks in women have been found to be more difficult to recognize than those in men and can sometimes lead to worse complications. Testing done in the hospital tends to be less obvious in showing a heart attack and when it a woman presents and doctors often find that the cause of the heart attack isn’t what they expected. Women have also been shown to come in to the hospital with symptoms that aren’t typical, which can delay getting good treatment. Research has now started to show that some of these differences are actually based in the different biology of men compared to women. For example, the way that cholesterol builds up in the arteries is different for men compared to women, partly because of hormones, which might explain why their symptoms and test results can be different as well. This is just one instance of what researchers are realizing is a much larger picture of why considering gender is so important when it comes to heart disease.
What sorts of symptoms are more typical in women?
You’ve probably seen movies or TV shows that portray a person having a heart attack: they grab their chest in crushing pain, struggle to breathe, and might look pale, sweaty and lightheaded. While women can present this way, they also often have some symptoms that don’t fit this picture, including:
- Chest pain that’s sharp, burning, aching or worse when they breathe
- Flu-like symptoms
- Anxiety or fear
- Racing heart (heart palpitations)
- Pain in the abdomen
This means a woman could, and often does, show up at a hospital and get worked up for many other things before getting a workup for a heart attack because their symptoms don’t fit the usual heart attack picture.
What diseases put women more at risk for heart disease?
One major point in the study is that women and men are affected differently by the risk factors for heart attacks. Here are a few risk factors the group found for women:
- Smoking causes worse heart disease in women and is the biggest risk factor for women under 55 who have a heart attack.
- High blood pressure is a bigger risk factor in women than in men.
- The role of blood cholesterol and blood lipid levels still seems somewhat murky in women, although having low HDL is a bad sign.
- Diabetes and obesity jump the risk of having a heart attack more in women than it does in men, especially in young women.
- Chronic stress, which women report experiencing in higher levels than men, is a strong risk factor in women.
- Depression, which is more common in women than in men, is a risk factor for heart attack.
The fact that these illnesses affect women and men differently could explain part of why heart disease is more common in women than in men and why their heart attacks look different.
Were there any differences in complications after having a heart attack?
One complication the research team found that is often skipped over is sexual problems. Because good blood flow is so important for sexual function, sexual problems can arise when a heart attack makes it harder for the heart to pump blood the way it needs to. While doctors often talk to men about these problems, they often fail to mention them to women. Higher rates of some mental health problems in women have also been linked to the fact that more women have complications after having a heart attack than men.
Why are these differences such a big problem?
All of these gender differences can add up to big issues when women actually seek help for the symptoms they’re having. Their risk factors for heart disease may or may not fit the typical profile and their symptoms may not be what doctors are expecting from someone having a heart attack. That can delay when a woman gets the right treatment and might add to the tests and overall risks she’s exposed to in the hospital. At worst, that could be the difference between life and death. After a heart attack, it’s also important to recognize the differences between men and women in recovering so that the unique needs of women are addressed as they get better.
Who should be taking action?
The authors of the statement point out that this knowledge needs to get both to the public and to the medical community. Doctors need to search for heart attacks in women even when the clinical picture they’re getting doesn’t add up to the stereotype. But the public also has a role to play. Other research they looked at showed that women are more likely to delay going to the hospital and to put the health needs of others before their own. That can mean putting off a doctor visit or not going to rehabilitation after a heart attack because of family commitments. This is potentially why women who do go to the hospital are in worse shape than men having a heart attack and have higher complication rates and a higher risk of death from heart attacks.
Was there more information in the statement?
The research team looked at over 400 studies to put the statement together and their findings were far-reaching and extensive. Fortunately, you don’t have to read through all of it. If you want to know more, the AHA has a lot of information on their website. You can also talk to your doctor about whether you’re at risk for heart disease, what to look out for, and what steps you can take to lower your risk.
Why is this important for me?
It’s important to know how heart attacks can differ between men and women so that you don’t write off what could potentially be a heart attack without the typical symptoms. You should also find a time to talk to your doctor about your risk factors and what you might do to cut down on your chances of having a heart attack. And most importantly, take care of yourself if something seems wrong. As the researchers pointed out, many women are seeking medical help late because they often put the needs of others above their own. Even if you’re relatively young and not the typical heart disease patient, being checked out by a doctor can put your mind at ease and ensure any problems are picked before it’s too late.