Heart-health experts have spent a lot of time and effort alerting women to the dangers of cardiovascular disease and educating them about heart attack symptoms. The hope was that, armed with this knowledge, women would have the necessary tools to help prevent heart disease and its complications.
But it’s been an uphill battle, with many women unaware that their number-one killer is cardiovascular disease, the group of disorders of the heart and blood vessels that includes coronary artery disease, cerebrovascular disease, and other conditions.
Surveys have found that many women still think heart disease is a man’s disease and fail to see themselves at risk for it. They may not even know the common symptoms of a heart attack in women, which are often different from those in men. For this and other reasons, diagnosing heart disease can be more difficult in women.
The good news is that, in women as in men, age-adjusted mortality rates from coronary artery disease have fallen by about two-thirds since 1980, attributed to reductions in major risk factors because of lifestyle changes and medication. However, even with the gains that have been made, there’s room for more improvement.
Why gender matters
A lack of understanding among women about cardiovascular disease may not be too surprising. Clinical trials that study heart problems have traditionally focused on men, which left women out of the loop when it came to the most effective treatment for their needs.
Men have gotten more attention from doctors and researchers because they tend to develop coronary artery disease about 10 years earlier than women, with women being protected by higher premenopausal levels of estrogen. This age disparity leads many women to discount their risk. By age 75, however, a woman’s risk is equal to a man’s. If a woman smokes or has diabetes, hormonal protection against cardiovascular disease is all but lost.
Women’s knowledge of the gender differences in heart attack symptoms could be better, too. In a 2013 study published in the journal Clinical Cardiology, researchers found that just 67 percent of women knew how their warning signs for a heart attack could differ from men’s.
For example, though chest pain or pressure is the most common symptom of a heart attack in both men and women, more women do not have this classic symptom. Because their heart attack symptoms are different, more diverse and less well known, women are less likely to recognize their symptoms and seek immediate help. One study found that only one in four women having symptoms of a heart attack called 911 or went to the hospital.
Doctors may not recognize a woman’s symptoms, either. As a result of misdiagnosis and/or delayed treatment—and because they tend to be older when they have a first heart attack—women are more likely to die of a heart attack than are men.
The age factor
Before age 50, heart attacks are far more common in men than in women, largely because of the protective effect of the female hormone estrogen. After menopause, however, naturally decreasing levels of estrogen lead to an increase in LDL cholesterol levels, a drop in HDL cholesterol, and thus a rise in a woman’s risk of a heart attack.
If a woman experiences menopause before age 40 because she has had her ovaries removed or has experienced spontaneous ovarian failure, she is at much higher risk for a heart attack than the average woman her age.
After age 65, heart attacks occur in one in every four women, affecting many more women than breast cancer. In fact, just as many postmenopausal women as men die of a heart attack each year.
Know the signs, protect your heart
Preventing or properly managing cardiovascular disease is the optimal way to stop a heart attack from occurring in the first place. Recognizing the symptoms of heart attack—particularly those unique to women—can help save lives if one does occur.
Chest pain or discomfort is still one of the most common symptoms of a heart attack in women.
Other, more vague symptoms, which may occur alone or together, include:
• Pain in the arms, back, neck, jaw or abdomen
• Shortness of breath, with or without chest pain
• Gastrointestinal distress, such as nausea or vomiting
• Feelings of dizziness and lightheadedness
• Breaking out in a cold sweat
If you experience any of these symptoms, you should seek medical attention right away.
Researchers also seemed to find that women and their doctors aren’t having discussions about preventing cardiovascular disease, even if the women had risk factors. Some risk factors can’t be controlled, such as aging and family history. Others can be modified to lower heart risks—for women and for men—such as smoking cigarettes, high blood pressure, high cholesterol, obesity, diabetes, and physical inactivity.
Learn more about women and heart attack risks.