Health Matters: Heart Disease in Women

Is heart disease in women really different than in men? I have been asked this question many times while working in the Women’s Cardiovascular Clinic. We have learned this to be true over many years of research and thanks to pioneers in the field such as Dr. Nanette Wenger who once said that “sex health differences goes beyond bikini medicine.” We have moved from women’s health referring to only the parts covered by a bikini, and now acknowledge and practice cardiology with a background understanding that there really are sex health differences when it comes to cardiovascular disease.

The Numbers

So why should we care about women’s specific heart disease? The numbers tell the story. Heart disease is still the leading cause of death in women and is the cause of death in about one in every three females. There are seven times more women dying of heart disease than breast cancer every year. In fact, heart disease is the cause of death of more women every year than all cancer combined. In women over 20 years old, about 45% have some form of heart disease. Heart disease in the number one killer of new mothers and accounts for over one third of maternal deaths. We should care deeply about women’s heart disease, because chances are, there is a woman in your life who has been or will be affected by heart disease.

The Differences

When you begin to look, the differences in heart disease between men and women are not hard to find. Women have sex-specific risk factors for heart disease that are now incorporated into our guidelines.

A woman’s pregnancy health such as having hypertension, pre-eclampsia or gestational diabetes significantly increases the risk of developing heart disease later in life. The age of menopause and other common metabolic disorders that only affect women such as polycystic ovarian disease all have impacts on a woman’s risk of heart health.

There are also differences in the impact of traditional risk factors between men and women. For example, tobacco use and diabetes, although risk factors for heart disease in both men and women, increases the risk of developing heart disease in women more so than in a man.

There are different types of heart attacks that affect women more commonly such as spontaneous coronary artery dissection, SCAD, as well as heart attacks or chest pain caused by the small vessels in the heart, whereas men more commonly have blockages within the big blood vessels of their heart. Men are more likely to develop atrial fibrillation, however women are more likely to have a stroke if they do develop atrial fibrillation. Heart failure is more common in women, however women are less likely to receive lifesaving treatments or procedures for this. Overall, women have more complications and have worse outcomes if they have heart disease-there are many different reasons for this, among them is that women are not as highly represented in clinical trials for heart disease and women are less likely to receive the guideline recommended medications and treatments for heart disease.

The Good News

Hearing all of this information can certainly feel overwhelming. There are differences and it feels like the odds are against women when it comes to their heart health. But there is power in knowledge and if we know the facts and understand our risks, then we can start to make changes to prevent heart disease. Women can reduce their risk of heart disease by over 80% just by following a heart healthy lifestyle- not smoking, maintaining a healthy body weight, consuming a healthy diet, participating in regular exercise, and consuming no more than moderate amount of alcohol. These facts and differences sparked my own interest and passion to learn more about women’s cardiovascular disease so that we can team up with our patients to help keep the hearts of our mothers, sisters, grandmothers, neighbors, and friends healthier and happier for longer.