17 Ways Heart Health Varies in Women and Men
Heart disease is the No. 1 cause of death for a lot of women – just like men. For both sexes, about 1 in 4 deaths is due to heart disease, which killed more than 292,000 women and about 307,000 men in 2009, according to the Centers for Disease Control and Prevention. What is different is awareness – health care providers and the general public tend to be more attuned to heart risks and heart attack symptoms in men. Below is how heart health and care can vary between the sexes.
In younger adults, certain risk factors are higher for men.
Until age 45, a higher percentage of men than women have high blood pressure, a heart disease risk factor. Between 45 and 64, however, hypertension rates even out, according to the American Heart Association. And women enjoy another early advantage. “For young women who are still premenopausal because of estrogen, their cholesterol tends to be very normal-looking,” says Dr. Helene Glassberg, a cardiologist and associate professor of clinical medicine with Penn Medicine. “And it’s very important to maintain that with good diet and exercise.” After menopause, estrogen’s protective effects fade.
Bikini lines often define women’s health.
The medical community has long taken a “bikini approach” to women’s health, says Dr. Martha Gulati, chief of cardiology for the University of Arizona College of Medicine–Phoenix. “We look at their breasts and reproductive systems.” The bikini definition, coined by Dr. Nanette Wenger in the 1990s, still applies today, Gulati says. Women’s health centers across the world are usually run by gynecologists or cancer physicians, she says, with breast cancer and maternal-fetal health often the focus. “Rarely do you see a women’s health center that actually also encompasses cardiovascular disease.”
Smoking poses even more risk to young women.
“Cigarette smoking seems to be a more potent risk factor for young women than young men when it comes to developing heart disease,” Glassberg says. That’s distinct from the higher risk of blood clots seen in women smokers who use birth control pills, she notes. Tobacco use, in and of itself, is a stronger risk factor for developing plaque in the arteries and for heart disease among young women, she says.
‘Classic’ heart attacks occur in women, too.
Crushing chest pain, like an elephant standing on your chest; pressure, as if a rubber band is squeezing your heart; shortness of breath; pain shooting down your left arm and radiating up to your jaw are classic signs of a heart attack – no matter your gender. “We want every woman to understand that if they have these symptoms, you know what, you’re probably having a heart attack,” Gulati says. “Because two-thirds of women will have typical symptoms.”
Some women have more subtle signs.
About a third of women don’t experience chest pain or pressure during heart attacks, Gulati says. They may have isolated jaw, back or shoulder pain that can’t be explained away or nausea. A common symptom is suddenly not being able to do something, like walk up a flight of stairs, which they could do the day before. Or women may feel profoundly fatigued. “Women are usually in tune with their bodies,” Gulati says. “If you think something’s wrong, that’s very important, especially if it’s related to getting short of breath with minimal exertion.”
Emergency land line is for everyone.
When a man clutches his chest and says, “I feel like an elephant’s sitting on my chest,” people react. “The question is: Would we pick up the phone and call emergency land line when a woman’s having the same symptoms or even having these more quote-unquote a typical symptoms?” Gulati says. “If you’re having a heart attack, the best thing we can do is open up that artery as quickly as possible. If it turns out you’re not having a heart attack, laugh about it later.” That, she says, is better than regretting never having called.
Your cardiologist is more likely to be a man.
Whether it makes any difference in terms of heart disease recognition or treatment is uncertain, but male cardiologists far outnumber female cardiologists. Between 11 and 12 percent of U.S. cardiologists are women, says Gulati, who is also the editor-in-chief of CardioSmart and a member the American College of Cardiology’s committee on cardiovascular disease in women.
Women are less likely to get recommended heart-attack care.
The American Heart Association’s Get With the Guidelines initiative looks at measures of clinical performance in U.S. hospitals. “These are some of the best hospitals that voluntarily present their data nationally,” Gulati says. “Yet we’ll see that women compared with men are less likely to get the standard of care when they present with having a heart attack. They’re less likely to get aspirin within 24 hours. They’re less likely to get a beta-blocker within 24 hours. These are lifesaving therapies that should happen the minute you think somebody’s having a heart attack.”
Men are more likely to receive certain procedures.
Women having a heart attack are less likely than men to be treated in a cardiac catheterization lab, Gulati says. “When you come in through the emergency room, our door-to-needle time should be less than 30 minutes,” she says. “Meaning, from the minute you hit the door of the emergency room, getting a needle into your groin to start a coronary cath or angiogram – it should be less than 30 minutes. That’s our goal for all hospitals and all patients.”
Certain medical conditions have more impact on women.
Inflammatory conditions such as lupus and rheumatoid arthritis are less-known risk factors for heart disease, Gulati says. “They’re inflammatory diseases, [and inflammation] is the basis of heart disease,” she says. “People – men and women – with rheumatoid arthritis are more likely to get heart disease.” The difference is that women are more likely to have these inflammatory conditions. Diabetes, a familiar risk factor for heart disease, seems to have a greater effect on women’s hearts, Gulati notes.
Apple-shaped bodies affect risk.
Overweight women who carry much of their fat around their waist – those with “apple-shaped” figures – are at greater risk for heart disease. “To fully know how excess weight affects your [heart disease] risk, you should know your BMI and waist measurement,” according to the National Heart, Lung, and Blood Institute website. “If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches, you’re at increased risk for [heart disease].”
Broken heart syndrome: rare but real.
Two extremely rare heart problems largely affect women, Glassberg says. Spontaneous coronary artery dissections involve tearing of the lining of the artery. “That seems to happen more frequently in women in their 40s and 50s that are peri menopausal and are taking estrogen,” she says. “Broken-heart syndrome,” or stress-induced cardiomyopathy, is thought to result from acute, abrupt stress or an adrenaline surge. Severe emotional stress, like the loss of a loved one, could contribute, Glassberg says, or physical stress like trauma.
Pregnancy complications can pose future heart risks.
Complications that affect women during pregnancy, such as preeclampsia (high blood pressure) and gestational diabetes, seem to disappear after delivery. “But what doesn’t resolve is the increased risk for cardiovascular diseases,” Gulati says. Heart disease could show up in the mother within 10 years or much later. Women who’ve had these events should make sure their cardiologist or primary care physician is aware, she says, so they can determine what screening is needed.
Hormone replacement requires caution for women.
Women going through menopause may take hormone replacement therapy to ease symptoms such as hot flashes, night sweats and vaginal dryness. “If you’re a post menopausal woman whose heart risk is very low, but you’re really being troubled by your postmenopausal symptoms, then maybe one year of hormone replacement therapy would not be an inappropriate thing to try,” Glassberg says. “But if you’re someone who’s at great risk for heart disease or you’ve already had a cardiac event, then taking hormones is probably something I’d recommend that a patient avoid.”
Testosterone supplementation requires caution for men.
“I have male patients coming in asking about taking testosterone supplements for a variety of reasons: energy, libido or whatever,” Glassberg says. “That’s still pretty controversial.” Recent scientific findings suggest testosterone supplement use might increase men’s heart risk.
E.D. could be a cardiac clue.
“Erectile dysfunction is actually a sign of cardiovascular disease until proven otherwise,” Gulati says. When a patient goes to a primary provider asking if he can have Viagra or Cialis, she says, the doctor should first determine whether he has any sort of vascular disease. If a man is taking certain heart medications like nitrates, combined drug effects can occur. “Those are people that are not ideal candidates to use the medications for erectile dysfunction,” she says.
Lifestyle changes help everyone.
Men, women [and children] all benefit from being more physically active, losing excess weight and following a heart-healthy diet. “Balance is the key,” says Glassberg, who mentions the Mediterranean diet as a way of eating that’s low in fat, low in meat products and high in fiber. “I would say the biggest problem in this country is processed food,” she says. “If you could pick one thing out of your diet, I would say processed food: the Doritos, the fast foods, the sodas.”