What People Don’t Know About Female Heart Health

When it comes to heart disease in women, the general public isn’t much further along than we were a half a century ago. Back in the 1950s and 1960s, heart disease was considered a man’s disease.

Women were thought to be naturally immune to heart disease due to their hormonal makeup until menopause, and doctors believed that hormone replacement therapy could further protect them from heart disease. A woman’s role in heart disease was to help take care of the men in their lives.

At the turn of the century, evidence began to indicate that heart disease also posed significant risks to women. Not only did doctors discover that heart disease impacted women as well as men, they also found that heart disease manifests differently in males and females. Since most of the research on heart disease up until the 1990s was done on male subjects, doctors had a difficult time recognizing heart attacks in women. 

Unfortunately, things haven’t changed enough since the days that heart disease was thought of a mostly male ailment. 70% of physician trainees in the U.S. report that they aren’t getting enough education in gender-based medical concepts during postgraduate medical training. In another survey, only 42% of cardiologists and 22% of primary care doctors felt extremely well prepared to assess cardiovascular risks specifically in women. 

Women More Likely To Die From Heart Disease

Though doctors are less likely to diagnose women with heart disease, women are actually more likely to die from heart disease than men due to misdiagnosis and undertreatment.

In the past decade, heart attack hospitalization rates among women – especially young women under the age of 55 – have risen, while rates among men in the same age group have dropped. Moreover, women are more likely to die from heart attacks. 

One of the biggest reasons behind this increased mortality rate is a discrepancy in care. Doctors are less likely to treat women with high cholesterol with statins, a type of drug that helps lower the risk for strokes and heart attacks. Doctors are also less likely to prescribe women blood-thinning drugs to prevent or treat blood clots, which then puts them at a higher risk of atrial fibrillation.

Modern guidelines to treat heart disease are based on studies done in the 1990s using almost exclusively male subjects, and even with today’s research, less than a third of study subjects are female. 

Differences Between Male And Female Heart Disease

The lack of research on female heart disease is particularly dire because heart disease has pronounced gender differences. Below are some of the key differences in male and female heart disease:

Different areas of cholesterol buildup

Heart attacks are caused by cholesterol plaque buildup inside the walls of arteries, damaging major blood vessels and restricting circulation. Men tend to develop cholesterol plaque buildup in the largest arteries that supply blood to the heart, whereas in women, plaque is more likely to accumulate in the smallest blood vessels of the heart, called the microvasculature. Inflammation also plays an important role in heart disease and may contribute to such gender differences. 

Different heart and blood vessel size

Differences in male and female anatomy and physiology extends to their cardiovascular systems. Women have smaller hearts and narrower blood vessels than men, which means heart disease can progress differently in women. However, women are still being diagnosed and treated with the same tests, procedures, and medications as men. 

Different heart attack symptoms

Heart attacks may not always exhibit the same symptoms in men and women. The most common reported symptom of male heart attacks is chest pain. While chest pressure is the leading complaint in women, they are more likely than men to report:

• Sweating
• Nausea
• Pain in the jaw, neck, throat, back, or abdomen
• Vomiting

Different risk factors for heart disease

General risk factors like obesity, smoking, and high blood pressure remain the same among both genders, but women may also have other risk factors to be aware of. Some risk factors for heart disease in women include:

• Preeclampsia
• Gestational diabetes
• Endometriosis

Women are more likely to have diseases that mimic a heart attack

Women are more likely than men to experience diseases with similar symptoms as a heart attack, including:

• A coronary spasm
• A coronary dissection 
• Broken heart syndrome – this is when enzymes in the blood and changes in the heart muscles mimic a heart attack, but without any blocked arteries

Different requirements for diagnostic heart care

When a woman presents the signals of a heart attack to a health care provider, the provider may not be able to diagnose correctly by using the same diagnostic methods as they would on a man. Cardiac troponin (cTn) tests are used to diagnose suspected heart attacks in both men and women.

This test measures circulating levels of troponin, a protein that is released in the blood when heart muscle is damaged by a heart attack. Higher levels of troponin are correlated to more heart damage. However, some women may be having a heart attack but fall below the level of detection.

Cardiac catheterization is another common test for diagnosing heart attack, but since this test focuses on blockages in large arteries, it may not be accurate in women as women are more likely to experience higher amounts of plaque buildup in the smallest arteries.