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Historically, heart disease has been thought of as a condition that mostly affects men. But in reality, heart disease is also one of the leading causes of death in women and is a risk that is often underestimated by women and their healthcare providers (ESC). Most medical knowledge about heart disease and how to treat it has come from studying men, and these findings became the standard of care for both men and women. However, emerging evidence has shown that women often have different symptoms, risk factors, and treatment needs than men when it comes to heart disease. Women may experience heart disease in a different way than men or have their symptoms attributed to other health problems by doctors, leading to under treatment and poorer treatment outcomes (Woordward, 2019). Understanding gender-based differences in heart disease is necessary in order to correctly inform women of their risk, help them recognise the symptoms of a potential heart emergency, and take steps toward prevention.
What is heart disease?
The term “heart disease” refers to a group of conditions that affect the heart. The most common type of heart disease is coronary artery disease (CAD), a condition that affects the vessels that supply blood to the heart (CDC, 2023). Deposits of cholesterol (plaques) in the arteries that reduce blood flow to the heart are the most common cause of CAD and is also known as atherosclerosis. Atherosclerosis can cause angina (chest pain), heart attack (sudden blockage of blood to the heart), or stroke (sudden blockage of blood to the brain).
Another common type of heart disease is heart failure. Heart failure can occur when the heart is damaged or weakened, such as from high blood pressure or heart attack. As the heart is unable to meet the body’s demands for blood and oxygen, symptoms of fatigue and shortness of breath may develop (NHS, 2022).
Other types of heart disease include arrhythmias (irregular heartbeats), diseases of the heart muscle/valves, heart problems that people are born with (congenital heart defects), infections, or enlarged heart muscles (NHS, 2022).
Gender based differences in heart disease
The structure of the heart
Although at first glance a woman’s heart looks like a man’s, there are several differences in the size and function. For example, a woman’s heart is smaller and the walls separating the ventricles are thinner than in men. A woman’s heart also pumps faster, but as much as 10% less blood is pumped into the arteries per contraction than in men. In addition, the female heart responds differently in stressful situations. In women, the heart rate increases and more blood is pumped through the body in response to stress. In men, the heart’s veins contract and blood pressure rises (Michigan Cardiology, 2019).
Estrogen and heart health
The hormones that naturally occur in women and men also affect heart disease risk. Estrogen is a female sex hormone that helps regulate the menstrual cycle and can also provide some protection against coronary artery disease and risk of heart attack. Estrogen also helps control cholesterol levels and reduces the risk of plaques building up in artery walls (Cleveland Clinic, 2019). During menopause, the amount of estrogen in the body decreases. Lower estrogen levels can cause the vessels in the heart to become stiffer or for plaque to build up. While younger women have a lower risk of heart disease before menopause, that risk increases later in life. Postmenopausal women are recommended to be extra vigilant of risk factors for heart disease, including watching their blood pressure, exercising regularly, eating a heart-healthy diet, and not smoking (Williams, 2020).
Risk factors for heart disease in women
Primary risk factors for heart disease in women are similar to those in men, such as high blood pressure and high cholesterol. However, there are also risk-factors specific to women such as those related to reproductive health and pregnancy. Other risk factors for heart disease in women include:
- Obesity
- Smoking or drinking too much alcohol
- Stress
- Complications during pregnancy, such as preeclampsia (high blood pressure), gestational diabetes, or preterm birth
- Heart conditions during pregnancy, such as periomyopathy
- Early first period (before age 11)
- Early menopause (before age 40)
- Inflammatory diseases such as lupus or rheumatoid arthritis
- Diabetes: women with diabetes are more likely to develop heart disease than men with diabetes
Source: CDC, 2023, Mayo Clinic
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Symptoms of heart attack in women
While many symptoms of heart attack are the same in women and men, women may have less obvious or different symptoms than what is seen in men. Symptoms in women can be less specific and are sometimes confused with other, less serious conditions such as indigestion or anxiety. If you are experiencing any of the following symptoms, it is important to seek emergency medical care right away.
Common symptoms of heart attack in women and men
- Shortness of breath and difficulty breathing.
- Chest pain or pressure
- Anxiety
- Nausea or lightheadedness
- Chest pain during exercise
- Pain radiating to the left arm or left shoulder.
Symptoms of heart attack more common in women
Women may have symptoms of heart disease or heart attack that are more subtle and difficult to recognise. This could include shortness of breath, indigestion, back pain, or nausea even in the absence of strong chest pain. Symptoms of heart disease or heart attack in women can also include:
- Cold sweats, nausea or lightheadedness
- Pain in the jaw, neck, throat, stomach, or back
- Pain in the arm or shoulder
- Heartburn
- Sweating
Source: American Heart Association
Symptoms of heart disease in women
The symptoms of different heart diseases are often similar and it may be difficult to tell if they are caused by a heart emergency or a chronic condition that requires less urgent treatment. If you experience any of the following symptoms and are unsure if you are having a heart attack, seek emergency medical care to be sure.
Symptoms of coronary artery disease in women and men:
- Angina: an aching, burning, squeezing, or feeling of fullness in the chest
- Shortness of breath
- Heart palpitations
- Nausea
- Sweating
Symptoms of heart arrhythmias in women and men:
- Heart palpitations (fluttering feelings in the chest)
- Irregular heartbeat
- Fainting
- Fatigue
Symptoms of heart failure in women and men:
- Swelling of the feet or legs
- Shortness of breath
- Fatigue
- Rapid weight gain
Source: Yale Medicine
Symptoms of heart disease more common in women
In general, women with heart disease are more likely to experience the following symptoms:
- A dull ache, pressure, burning, or tightness in the chest (angina)
- Extreme weakness
- Sudden sweating
- Nausea
- Heart palpitations
Source: Cleveland Clinic, 2022
Diagnosing heart disease in women
Diagnosing heart disease begins with a trip to the doctor. The doctor will ask you about your symptoms, personal and family medical history, and lifestyle, such as how often you exercise or if you smoke. The doctor may also perform blood tests, such as a cholesterol and lipids test, complete blood count, or specific tests for markers of heart failure or attack.
In addition to blood testing, your doctor may order other tests, such as:
- Electrocardiogram (EKG): This test measures the electrical impulses of your heart and can be used to diagnose an arrhythmia or heart attack.
- Stress test: This test is done while exercising on a treadmill while wearing heart or blood pressure monitors. It provides information on how well the heart works during exercise.
- Echocardiogram: This test provides a picture of your heart using an ultrasound. An echocardiogram can be used to check for structural abnormalities in the heart and see how well it pumps blood.
- Coronary angiogram: This test may be done after a heart attack or angina. It involves placing a catheter (small tube) into an artery located in the groin, arm, or wrist. The catheter is moved through the artery until it reaches the heart. Special dye is then injected into blood vessels and an X-ray is taken, showing where and how much coronary arteries are narrowed or blocked.
- Heart CT scan or MRI: A CT scan or MRI takes images of the heart and chest. These scans can show potential blocked blood vessels or other problems with the structure of the heart.
Source: Mayo Clinic, 2022
Prevention of heart disease in women
Prevention of heart disease in women is similar to that in men and includes knowing your risk factors, controlling diseases that increate your risk of heart problems, and making healthy lifestyle choices. The following tips can help women prevent heart disease:
- Be aware of your risk: many women are unaware that heart disease is not only a concern for men- in fact, it is one of the most common causes of death in women too. Learning what factors increase your risk, whether you have a family history of heart disease, or whether you have other medical conditions that put you at risk of heart disease is the first step in prevention.
- Manage your medical conditions: High cholesterol, high blood pressure, and diabetes increase your risk of heart disease (FDA, 2022). If you have any of these conditions it is important to get regular checkups, take medications as directed, and discuss with your medical team whether lifestyle changes are needed to limit your risk of heart disease.
- Maintain a healthy weight and exercise regularly: although weight loss can be daunting, even slight weight loss has been found to be beneficial for heart health, even if some of the weight is regained later (Hartmann-Boyce et al., 2023). In terms of exercise, you can still make a difference in heart health without visiting the gym. Regular moderate exercise such as walking have also been found to improve heart health (Murtagh et al., 2010).
- Recognise the signs of a heart attack: as described above, the symptoms of a heart attack can be the same or different as those seen in men. If you are experiencing symptoms that could be a heart attack, seek emergency medical care immediately. Even if you’re not sure, getting help could save your life.
- Stop smoking: it’s no secret that smoking cigarettes does not do any favors for your health. In fact, smoking can increase your risk of heart disease and stroke 2-4 times that of a non-smoker (Johns Hopkins). In women, that risk is even higher; women who smoke have a 25% higher risk of developing heart disease compared to men who smoke (Gallucci et al., 2020). Stopping smoking can improve your overall health and result in a reduced risk of heart disease over time.
- Eat heart healthy: aim to eat fruits and vegetables with every meal and to choose whole grain carbs and lean meats when possible. Limit your intake of foods high in saturated and added sugars.
- Limit alcohol: Long term overconsumption of alcohol is linked to heart disease. Women are more susceptible to alcohol-related heart disease than men, even though they may consume less alcohol over their lifetime compared to men (NIH). Limiting alcohol use to one drink or less per day can help reduce your risk.
Interested in checking your heart health? Homed-IQ’s Heart Disease Test checks for two key markers that affect your risk of heart disease: cholesterol and lipids (total cholesterol, HDL, LDL, and triglycerides) and blood sugar. This test can be completed from home using a finger prick blood sample before being sent to a certified laboratory for analysis. If needed, the printable laboratory report can be brought to your GP for follow-up care.
Treating heart disease in women
Treatment for heart disease in women is similar to that in men and may include medication, lifestyle changes and, in some cases, surgery. The treatment for heart disease depends on the cause and type of heart damage. Possible treatments include:
- Lifestyle changes, such as eating a low-fat, low-salt diet
- Medications, such as statins, beta-blockers, ACE inhibitors, or blood thinners
- Heart surgery or other procedures, such as the placement of a pacemaker or coronary bypass
Through regular medical care and knowing the risks, heart disease can be diagnosed and treated early. If you have any concerns about your heart health, speak to your GP.
Source: Mayo Clinic, 2022
References
American Heart Association. (2022, December 5). Heart Attack Symptoms in Women. www.heart.org. https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women
Cardiology Associates of Michigan. (2019, December 11). Men vs. Women: How Their Hearts Differ and What It Means. Michigan Cardiology. https://www.cardofmich.com/men-women-heart-differences/
Cleveland Clinic. (2019, April 19). Estrogen & The Heart: Risks, Benefits & Side Effects. https://my.clevelandclinic.org/health/articles/16979-estrogen–hormones#:~:text=Estrogen%20helps%20a%20younger%20woman%27s,helps%20the%20blood%20to%20clot).
European Society of Cardiology. (n.d.). Cardiovascular Disease in Women. https://www.escardio.org/The-ESC/Advocacy/women-and-cardiovascular-disease
Fight Inflammation to Help Prevent Heart Disease. (2022, November 1). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/fight-inflammation-to-help-prevent-heart-disease
Gallucci, G., Tartarone, A., Lerose, R., Lalinga, A. V., & Capobianco, A. M. (2020). Cardiovascular risk of smoking and benefits of smoking cessation. Journal of Thoracic Disease, 12(7), 3866–3876. https://doi.org/10.21037/jtd.2020.02.47
Hartmann-Boyce, J., Theodoulou, A., Oke, J., Butler, A. R., Bastounis, A., Dunnigan, A., Byadya, R., Cobiac, L. J., Scarborough, P., Hobbs, R. J., Sniehotta, F. F., Jebb, S. A., & Aveyard, P. (2023). Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circulation-cardiovascular Quality and Outcomes. https://doi.org/10.1161/circoutcomes.122.009348
Heart disease in women: Understand symptoms and risk factors. (2022, January 20). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167
Heart Disease Resources | cdc.gov. (2023, March 21). Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/about.htm#:~:text=What%20is%20heart%20disease%3F,can%20cause%20a%20heart%20attack.
Johns Hopkins. (2020, July 20). Smoking and Cardiovascular Disease. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/smoking-and-cardiovascular-disease#:~:text=Facts%20about%20smoking%20and%20heart%20disease&text=Cigarette%20smokers%20are%202%20to,a%20person%27s%20risk%20for%20stroke.
Mayo Clinic. (2022, August 25). Heart disease – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/heart-disease/diagnosis-treatment/drc-20353124
Murtagh, E. M., Murphy, M. H., & Boone-Heinonen, J. (2010). Walking: the first steps in cardiovascular disease prevention. Current Opinion in Cardiology, 25(5), 490–496. https://doi.org/10.1097/hco.0b013e32833ce972
NHS. (2022, November 18). Common heart conditions. NHS Inform. https://www.nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/common-heart-conditions
NIH. (2023, March). Women and Alcohol. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/women-and-alcohol
U.S. Food and Drug Administration. (2022, January 25). Tips for Women to Prevent Heart Disease. Consumer Updates. https://www.fda.gov/consumers/consumer-updates/tips-women-prevent-heart-disease
Williams, V. (2022). Mayo Clinic Minute: Women, estrogen and heart disease. Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-women-estrogen-and-heart-disease/
Women and Heart Disease. (2023, February 21). Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/women.htm
Woodward, M. (2019). Cardiovascular Disease and the Female Disadvantage. International Journal of Environmental Research and Public Health, 16(7), 1165. https://doi.org/10.3390/ijerph16071165
Yale Medicine. (2019). Heart Disease in Women. Yale Medicine. https://www.yalemedicine.org/conditions/heart-disease-women
