Women May Experience Heart Disease Differently Than Men

Kathleen Kenny, PharmD, RPh

Pharmacy Times, June 2021, Volume 89, Issue 06

Help female patients stay informed about prevention strategies, symptoms, and treatment of this potentially deadly condition.

Heart disease is the leading cause of death in the United States for both men and women. Approximately 655,000 Americans die every year from heart disease. That equates to 1 person every 36 seconds. The condition costs the United States about $219 billion annually in health care services, lost productively, and medications.1

Despite increased awareness over the past few decades, only a little over half (56%) of women recognize that heart disease is as deadly for them as it is for men, according to the CDC.

In 2017, 299,578 women died from the disease.2

GENDER DISPARITIES

It is important to recognize that women sometimes experience heart disease differently than men. Women are less likely than men to experience chest pain. But they are more likely to experience back or stomach pain, chest pressure or tightness, dizziness, fatigue, indigestion, nausea, or shortness of breath.3-5

Survival rates after a heart attack are lower in women than in men. Compared with men, women are less likely to get advice about quitting smoking or receive potentially beneficial treatment, such as aspirin therapy and cholesterol-lowering medications.5 Doctors are less likely to refer women for certain diagnostic tests, such as an initial electrocardiogram, and younger women are more likely than men to receive a wrong diagnosis and be sent home after cardiac events.3

PREGNANCY

Preeclampsia, or high blood pressure (BP) during pregnancy, is a heart disease risk factor that increases the chances for blood vessel and heart problems later in life. In addition, having heart disease before pregnancy may raise the risk of pregnancy complications.3

MENOPAUSE

In middle age, risk factors for heart disease increase partially because of decreased estrogen production and weight gain. Women who go through early menopause, especially if they have had hysterectomies, have a higher risk of developing heart disease than those of the same age who have not gone through menopause. Hormone replacement therapy immediately after a hysterectomy may reduce the risk of heart disease. However, treatment later in life may increase the risk of heart disease.3

KEEPING HEALTHY

Although some risk factors cannot be changed, such as age and family history, women can take steps at every stage of life to maintain heart health. These include the following:

Knowing the risk factors. Patients should be aware of the various health conditions that increase the risk of developing heart disease. These include, but are not limited to, diabetes, hyperlipidemia, hypertension, and obesity.6

Managing health conditions. The health conditions listed above should be managed with lifestyle changes and/or medications. Hypertension is a major risk factor for heart disease. This occurs when the pressure of the blood in the arteries and blood vessels is too high. Primary hypertension has no identifiable cause and tends to develop gradually over time. Secondary hypertension is caused by adrenal gland tumors, certain medications, congenital blood vessel defects, kidney disease, obstructive sleep apnea, and thyroid problems. Secondary hypertension tends to appear suddenly and increase BP more than primary hypertension.7 Hyperlipidemia can cause fat deposits to build up in arteries, thereby narrowing the diameter the blood has to flow through, which then raises BP. Patients should have their cholesterol levels checked regularly and keep their numbers under 200 mg/dL total cholesterol.8

Individuals with diabetes are more than twice as likely to develop heart disease as those without diabetes. When insulin cannot properly manage glucose levels in the blood, the circulating glucose builds up and can damage blood vessels and the nerves that control them.9

Obesity causes the heart to work much harder than the heart of an average weight person. This raises BP and can contribute to heart disease through atherosclerosis, atrial enlargement, and ventricular enlargement.1

Recognizing Symptoms. Not all heart problems come with warning signs. Some heart symptoms do not even happen in or around the heart. Common symptoms include chest discomfort; dizziness; getting easily winded; heartburn; indigestion; irregular heartbeat; jaw, stomach, or throat pain; lightheadedness; nausea; pain that spreads down the arm; persistent cough; snoring; sudden fatigue; sweating; and swelling in the lower extremities.11

Engaging in regular physical activity. Exercise can help keep the heart healthy by boosting one’s mood, helping maintain a healthy weight, improving sleep, lowering BP, reducing stress, and strengthening the heart.12

Maintaining a healthy weight. Maintaining a healthy weight can also help manage cholesterol levels, diabetes, and hypertension.

Eating a healthy diet. Following the Dietary Approaches to Stop Hypertension diet includes eating beans, fish, fruit, low-fat dairy products, nuts, poultry, vegetables, and whole grains. It also means limiting foods that are high in saturated fat, sodium, and sugar or other sweeteners.13

Avoiding smoking. Chemicals in tobacco smoke, as well as flavorings found in vaping products, can damage the blood vessels, heart, and lungs. Even second-hand smoke can have these effects.14

Managing stress. Chronic stress can have negative effects on the heart. Stress can lead to hypertension, which can lead to heart disease. Stress can also contribute to other cardiovascular risk factors, such as increased alcohol intake, lack of physical activity, poor sleep, overeating, and smoking.15

Getting enough sleep. Most adults need 7 to 8 hours of sleep every night. Unfortunately, about one-third of American adults report not getting enough sleep. Not getting enough sleep or regularly getting poor-quality sleep increases the risk of heart disease, hypertension, and other medical conditions.16

Treatment of heart disease is similar in men and women. It can include angioplasty and stenting, coronary bypass surgery, and medications. Women are more likely to have complications after coronary bypass surgery than men.17

It is important to note that aspirin therapy is not recommended in women, unless they have already had a heart attack. Once they have a heart attack, daily aspirin therapy may help prevent another.17

REFERENCES

  1. Heart disease facts. CDC. Updated September 8, 2020. Accessed May 8, 2021. https://www.cdc.gov/heartdisease/facts.htm
  2. Women and heart disease. CDC. Updated January 31, 2020. Accessed May 8, 2021. https://www.cdc.gov/heartdisease/women.htm
  3. Listen to your heart: women and heart disease. National Heart, Lung, and Blood Institute. Accessed May 8, 2021. https://www.nhlbi.nih.gov/healthtopics/education-and-awareness/heart-truth/listen-to-your-heart
  4. Heart disease: differences in men and women. Johns Hopkins Medicine. Accessed May 8, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-disease-differences-in-men-and-women
  5. The heart attack gender gap. Harvard Health Publishing. April 12, 2016. Accessed May 8, 2021. https://www.health.harvard.edu/heart-health/theheart-attack-gender-gap#:~:text=At%20younger%20ages%2C%20men%20face,article%2C%20you%20must%20log%20in
  6. For women: the FDA gives tips to prevent heart disease. FDA. Updated February 3, 2021. Accessed May 8, 2021. https://www.fda.gov/consumers/consumer-updates/women-fda-gives-tips-prevent-heart-disease
  7. High blood pressure (hypertension). Mayo Clinic. Accessed May 8, 2021. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
  8. O’Keefe Osborn C. What you should know about hyperlipidemia. Healthline. Updated February 26, 2020. Accessed May 8, 2021. https://www.healthline.com/health/hyperlipidemia
  9. Citroner G. Why diabetes increases the risk of heart disease. Healthline. November 14, 2018. Accessed May 12, 2021. https://www.healthline.com/health-news/campaign-to-educate-people-with-diabetes-aboutheart-health#:~:text=According%20to%20the%20AHA%2C%20adults,disease%20than%20those%20without%20diabetes
  10. Obesity and cardiovascular disease risk. Cardiology Magazine. July 23, 2018. Accessed May 8, 2021. https://www.acc.org/latest-in-cardiology/articles/2018/07/06/12/42/cover-story-obesity-and-cardiovascular-disease-risk
  11. Five heart disease symptoms you should never ignore. NYU Langone Health. June 3, 2020. Accessed May 12, 2021. https://nyulangone.org/news/five-heart-disease-symptoms-you-should-never-ignore
  12. 5 simple ways [to] get moving for your heart health. Henry Ford Health System. June 5, 2018. Accessed May 15, 2021. https://www.henryford.com/blog/2018/06/5-simple-ways-get-moving-for-your-hearthealth#:~:text=%E2%80%9CGetting%20up%20and%20moving%20has,development%3A%20circulating%20fats%20and%20inflammation
  13. DASH diet: healthy eating to lower your blood pressure. Mayo Clinic. May 8, 2019. Accessed May 15, 2021. https://www.mayoclinic.org/healthylifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456
  14. How smoking affects heart health. FDA. Updated May 4, 2020. Accessed May 15, 2021. https://www.fda.gov/tobacco-products/health-information/how-smoking-affects-heart-health
  15. Chronic stress can cause heart trouble. American Heart Association. February 4, 2020. Accessed May 8, 2021. https://www.heart.org/en/news/2020/02/04/chronic-stress-can-cause-heart-trouble
  16. How does sleep affect your heart health? CDC. Updated January 4, 2021. Accessed May 8, 2021. https://www.cdc.gov/bloodpressure/sleep.htm#:~:text=Insomnia%20is%20linked20to%20high,active%2C%20and%20unhealthy%20food%20choices
  17. Heart disease in women: understand symptoms and risk factors. Mayo Clinic. Updated October 4, 2019. Accessed May 8, 2021. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167
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