Gender can play a role in risk factors, symptoms.
By Dr. Sanjay Gupta
Heart disease does not discriminate. It is the leading cause of death in the United States for men and women, claiming more than 600,000 lives each year, according to the Centers for Disease Control and Prevention. But there are gender differences that women need to be aware of.
During a heart attack, “time is muscle,” says Richard Krasuski, MD, a cardiologist in Cleveland, Ohio. “The quicker you get treated, the more heart you can salvage.” Being able to spot the first sign of an attack is critical, but that sign may not be one you typically think of.
“When women come into the hospital, they may not describe the ‘Hollywood heart attack,’ clutching the chest with the pain radiating down the arm,” says Nieca Goldberg, MD, director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center. “Instead, they feel pressure lower down in the chest, shortness of breath, or upper back pressure between the shoulders.”
Women may experience jaw, neck, or throat pain, fatigue, nausea, and dizziness. Not recognizing these as potential signs of a heart attack can delay getting medical attention.
A study published this week in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes suggests that symptoms of anxiety disorder, such as palpitations, may mask signs of heart disease in women. This can lead to misdiagnosis and worse cardiac outcomes.
“One of the major trends in the last 20 years in cardiovascular medicine is that you have to intervene early,” says Marla Mendelson, MD, a cardiologist at Northwestern Memorial Hospital and the medical director of the Center for Women’s Cardiovascular Health at the Bluhm Cardiovascular Institute in Chicago.
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“If somebody’s having [a heart attack] and they sit home and say, ‘I think it’s my stomach. It’s probably something I ate,’ then they’re not going to benefit from our advances in heart disease that can really help them,” Dr. Mendelson says.
Men and women share many of the same risk factors for heart disease, such as family history, obesity, tobacco use, and hypertension.
When it comes to age, “women tend to get cardiovascular disease a little bit later than their male counterparts because they do get some protection from [the hormone] estrogen,” Mendelson says. Estrogen benefits heart health by keeping blood vessels flexible and making blood flow easier.
Researchhas shown that women’s risk of heart disease rises after menopause, when menstrual periods stop and estrogen production drops. Younger women who experience early menopause “lose their estrogen early, so that puts them at risk,” Mendelson says.
Conditions related to pregnancy can raise a woman’s heart disease risk. A 2014 study in the Journal of the American Heart Association linked gestational diabetes, a normally temporary type of diabetes that occurs during pregnancy, with a hardening of the arteries, or atherosclerosis.
Similarly, women who develop high blood pressure associated with pregnancy, known as preeclampsia, are twice as likely to develop heart disease in the future.
Goldberg recommends that women with these conditions see a cardiologist in conjunction with their general practitioner. “That way, she is in the system and is getting tracked,” she says. “Her risk factors can be evaluated more in depth, so she can get the help and guidance she needs.”