Written by: Lexie Villariasa
Medically reviewed by: Robert Philibert MD PhD
Cardiovascular disease (CVD) is the leading cause of death in the United States. But many of these deaths are preventable. This is especially true for women, as more and more research shows that gender plays a role in altering risk for heart disease. While most of our concepts about heart disease come from studies done in men, emerging evidence shows that heart disease presents differently in women. For instance, women sometimes don’t experience angina or chest pain. Instead, they may experience neck and jaw pain or shortness of breath without exertion. This lack of general awareness of gender specific differences can lead to undertreatment of women, leading to more adverse outcomes. It is important to understand what these sex-dependent differences are to ensure proper prevention and treatment.
Gender Differences in Cardiovascular Disease
There are common risks shared between men and women such as high blood pressure, high cholesterol, diabetes, and obesity. However, there are many relative gender specific differences that affect the risk and treatment of CVD.
- For example, certain diseases specific to women such as PCOS and endometriosis, may increase the risk of coronary heart disease (CHD). In particular, endometriosis can increase the risk for CHD by 400% in women under the age of 40. Women are also much more susceptible to heart attacks as they age. This is because protective effects of estrogen decrease after menopause. Estrogen works by increasing HDL (good) cholesterol and decreasing LDL (bad) cholesterol. Once menopause begins and estrogen levels decrease, women begin to experience higher levels of total cholesterol, LDL, and triglycerides. This phenomenon is part of the reason why the average age for women suffering from heart attacks is 70, but around 65 for men.
- While diabetes is a risk factor for both genders, it is even more dangerous for women . Women are more likely to have additional factors like obesity, high cholesterol, and high triglycerides than men that magnify the effects of diabetes. For those women who have already suffered from a heart attack, the risk for a second one doubles if diabetes is also present.
- Metabolic syndrome is also more prominent in women and one of the most important risk factors for developing heart attacks at an early age. Symptoms of metabolic syndrome include glucose intolerance, elevated blood pressure, low HDL, and high triglyceride levels. Each of these symptoms, in turn, are also linked to greater risk for CHD.
- Women who smoke are more likely to relapse and have a heart attack compared to men who smoke. Nicotine replacement therapy, a standard smoking cessation therapy, may not be as effective in women as compared to men due to hormone imbalances affecting tobacco withdrawal symptoms.
- Anatomic factors also may play a role.For example, on average, women have smaller arteries than men do. As a consequence, procedures such as angioplasty and coronary bypass surgery become much harder to perform, reducing optimal outcomes and treatment. This may also lead to more complications following surgery.
- Coronary heart disease (CHD) can be harder to diagnose in women. CHD often preferentially affects small arteries in women, which are difficult to see in an angiogram. As a consequence, important pathological changes may be missed. Even though a woman may be “cleared” at her screening, it is important for her to see a specialist if symptoms continue to persist.
- Lack of appreciation of gender differences may result in suboptimal medication treatment. For example, after a heart attack, women pose a greater risk in developing blood clots. However, they may not always be given anticoagulants to prevent these clots. Typical medications given for CVD include statins, aspirin, ACE inhibitors, beta blockers, diuretics, and calcium channel blockers. In a study published in the Journal of the American Heart Association by a group of European researchers led by Dr. Min Zhao, the results showed that women were less likely to be prescribed statins, ACE inhibitors, and aspirin. This study contributes yet additional evidence that women are less likely to be given guideline-recommended medications compared to men.
Receiving Optimal Care
In summary, both men and women should take steps to ensure they are receiving the best possible care for their heart. This not only includes routine check-ups at the doctor and periodic risk assessment screenings (such as Epi+Gen CHD), but also taking additional preventative measures. Such extra measures include being physically active, quitting smoking, and incorporating heart-healthy meals. During doctor visits, it is important to assess individual risks, symptoms, and treatment options. For women, this is especially important to discuss all new experiences and not “shrug off” the sign of an impending, but preventable heart attack.