Heart disease in women

Do you know that heart disease is the leading cause of death in women? Every year, coronary artery disease (clogged arteries) affects 6.6 million women in the United States. It’s also the leading cause of long-term ill health and death among women.

In 1984, the American Heart Association (AHA) started keeping yearly reports on death rates due to heart disease. But even with better information and treatments, women are still more likely to die from a heart attack than men. 

Why is heart disease a women's issue?

The AHA gives three main reasons why women outnumber men in death by a heart attack:

• Symptoms in women are different than those for men.
• Women are less likely to report symptoms than men.
• Treatment, if used, can negatively affect women’s health in the short term, despite a high rate of survival.

Other factors that affect women’s heart health are biology, the pressures of daily life and menopause. Also, most heart-health studies have been done on men, who don’t go through menopause. 

The effects of menopause and the related decrease in estrogen on heart health are not fully known. It’s also difficult to know if heart-health changes are caused by a shift in hormones or by aging in general.

Women’s symptoms are different than men’s

The traditional image of a man clutching his chest is how many of us imagine a heart attack. But that doesn’t apply to women. Women’s symptoms are different and present more slowly. They may also go away, happen again or increase over time. 

In fact, shoulder and arm pain are twice as likely to predict a heart attack in women compared to men. Heart attack symptoms in a woman include:

• Sharp and sudden pain in the upper arm, neck and/or jaw
• Upset stomach and vomiting
• Sudden shortness of breath

These symptoms sometimes result in misdiagnosis and a delay in receiving appropriate care.

Women may not react to symptoms quickly

Many women, especially young women, fail to see their chances of getting heart disease even if it runs in their family. They may also not focus on preventive heart care. 

Also, growing evidence suggests that depression and related issues can lead to negative heart health outcomes. Women suffer from depression at twice the rate of men in the general population.

Because women’s symptoms don’t include the chest pain that’s common in men, women may not think they’re in danger. Social and psychological barriers can also keep women from getting medical attention for symptoms of a heart attack. 

These include:

• Lack of awareness of risk
• Not seeing the symptoms as urgent
• Older age
• Living alone
• Fear and embarrassment
• Language barriers
• Caregiving for aging spouse or parents and neglecting their own symptoms

Getting care can be overlooked and delayed

Even though women have more cardiac risk factors, preventive efforts are used less often for women. These include steps like cholesterol-lowering medication and help quitting smoking. 

In fact, cigarette smoking is the single most important preventable cause of heart attack in women. The rate of smoking in the United States has gone down over the years. Smoking is less common among women than men.

Many treatments for heart attack symptoms pose certain risks for women even though those treatments could save lives. For example, the medication that can break up a coronary blood clot (thrombolytic therapy) can cause bleeding on the brain in women. 

In addition, many female patients have other conditions that may make doctors reluctant to use thrombolytic therapy. These include high blood pressure, age and small body size.

How to reduce the chances of heart disease

There’s a lot you can do to reduce your risk of heart disease and improve your chances for a longer, healthier life. 

First, learn more about some of the risk factors for heart disease:

• Family history of heart disease or heart attacks
• Abnormal cholesterol (fat in the blood)
• Smoking
• Diabetes
• High blood pressure
• A lack of regular exercise

Then take steps to lower the risks you can control. These include eating heart-healthy foods, exercise and seeing your doctor regularly.

Humera Ali, MD, is board certified in cardiovascular disease. She works with patients with all types of heart disease. She has a particular interest in preventing and treating advanced forms of heart disease. 

Dr. Ali sees patients at The Polyclinic Madison Center and Issaquah. To schedule an appointment, call 1-206-860-2302.  

By Humera Ali, MD, FACC, FRCPC

The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.