Heart disease in women: Understanding symptoms and risk factors

By Warren L. Selkow, Patient

A few years ago, all right, more than a few years ago, I recall reading a very long article in the Wall Street Journal about how women had finally achieved equality with men. It was not in women’s ability to get through the glass ceiling, although women had made very significant advancements into the executive suites, it was in the fact that women were suffering the same work related diseases men had. I am sure women the world over found the article reassuring. Women were smoking, eating, drinking and not exercising just like their male counterparts and they were now getting just as sick. “Ain’t” progress great.

Years later, while writing The Simplified Handbook for Living With Heart Disease and Other Chronic Diseases I would learn that progress had reached into every negative nook and cranny of our lives and nowhere was that now more apparent than in the rate women now had heart disease.

Here is the first staggering statistic regarding women and heart disease: More women than men now have serious heart disease. Actually, women get heart disease at the same statistical rate than men get heart disease. Why do more women have heart disease than men? Simple, there are more women than men.

All women face the threat of heart disease.

Although heart disease is often thought of as a problem for men, more women than men die of heart disease each year. Women are six times as likely to die of heart disease as of breast cancer. Heart disease kills more women over 65 than do all cancers combined.

One challenge for women is that their heart disease symptoms can be different from symptoms in men. Fortunately, women can take steps to understand their unique symptoms of heart disease and to begin to reduce their risk of heart disease. It has now been recognized heart disease in women may be very different than heart disease in men.

In a paper published in Journal of the American College of Cardiology, on Monday, October 12, 2009, a prominent group of cardiologists pointed out heart disease effects more women than men and that women’s’ heart disease is different. It is so different, the group recommends a different diagnosis. The cardiologists recommend the term “ischemic-heart disease” to differentiate the disease as displayed by women.

The cardiologists point out treatment usually focuses on obstructive coronary heart disease, which is typified by arteries becoming blocked with plaque. (Thank you low-density lipids). Although women suffer from this same symptom, many more suffer from ischemia, which is defined as inadequate flow of blood through the body. In this condition the veins become constricted as opposed to blocked.

The use of a common label has serious consequences, namely women have far worse outcomes than men. The treatment for coronary artery disease (as suffered by men) is different than the treatment for ischemic-heart disease (as suffered by women). The result is women have far worse outcomes than men. (Translation: women die faster than men.)

The cardiologists go on to state the name change would allow for better testing and treatment for women. The name change may (I love the way professionals waffle using the word “may” – they don’t say “will” knowing that all their brethren won’t get the message) help doctors tailor diagnostic tests and treatments to better suit both men and women.

What are the symptoms of a heart attack for women?

The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it's not always severe or even the most prominent symptom, particularly in women. Women are more likely than men to have signs and symptoms unrelated to chest pain, such as:

  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These signs and symptoms are subtler than the obvious crushing chest pain often associated with heart attacks. This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease.

Many women tend to show up in emergency rooms after much heart damage has already occurred because their symptoms are not those typically associated with a heart attack. If you experience these symptoms or think you're having a heart attack, call for emergency medical help immediately. Don't drive yourself to the emergency room.

What are the heart disease risk factors for women?

Although the traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — affect women and men, other factors may play a bigger role in the development of heart disease in women. For example:

  • Metabolic syndrome — a combination of fat around your abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than on men.
  • Mental stress and depression affect women's hearts more than men's.
  • Smoking is a greater risk factor for heart disease in women than in men.
  • Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease).

Is heart disease something only older women should worry about?

No. While heart disease is the leading cause of death for women 65 and older, it's the third-leading cause of death for women 25 to 44 and the second-leading cause of death for women 45 to 64. Women under the age of 65 who have a family history of heart disease should pay particularly close attention to the heart disease risk factors. Still, all women, of all ages, should take heart disease seriously.

Is depression a unique risk factor for heart disease in women?

Depression is twice as common in women as in men, and it increases the risk of heart disease by two to three times compared with those who aren't depressed. Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment, so talk to your doctor if you're having symptoms of depression, such as loss of interest in your daily activities, feeling hopeless or unexplained changes in your weight.

What can women do to reduce their risk of heart disease?

There are several lifestyle changes you can make to reduce your risk of heart disease:

  • Exercise 30 to 60 minutes a day on most days of the week.
  • Maintain a healthy weight.
  • Quit or don't start smoking.
  • Eat a diet that's low in saturated fat, cholesterol and salt.

You'll also need to take prescribed medications appropriately, such as blood pressure medications, blood thinners and aspirin. And you'll need to better manage other conditions that are risk factors for heart disease, such as high blood pressure, high cholesterol and diabetes. Some women at high risk of heart disease may also benefit from the use of supplements, such as omega-3 fatty acids.

What type of exercise should you do to reduce your risk of heart disease?

In general, you should do moderate exercise, such as walking at a brisk pace, for 30 to 60 minutes most days of the week. If you can't get all of your exercise completed in one session, it's fine to break up your physical activity into several 10- to 15-minute sessions. You'll still get the same heart-health benefits.

There are other small changes you can make to increase your physical activity throughout the day. You can take the stairs instead of the elevator, walk or ride your bicycle to do errands, or try some sit-ups or push-ups while watching television.

What's a healthy weight?

What's considered a healthy weight varies from person to person, but having a normal body mass index (BMI) is helpful. This calculation helps you see if you have a healthy or unhealthy percentage of body fat. A BMI of 25 or higher can be associated with an increased risk of heart disease. Losing just 10 to 15 pounds can help by lowering your blood pressure and helping to prevent diabetes — both of which increase your risk of heart disease.

Is the treatment for heart disease different for women?

In some women, plaques build up as an evenly spread layer along artery walls, which isn't treatable using procedures such as angioplasty and stenting designed to flatten the bulky, irregular plaques in some men's arteries. For some women, drug treatment — rather than angioplasty or stenting — may be a better option.

Certain heart medications, such as clot-busting drugs (thrombolytics) tend to be more effective in women than in men. Aspirin therapy benefits both men and women, but there's also a difference between men and women in the effects of aspirin therapy. In women, aspirin therapy seems to reduce the risk of stroke more than in men, while in men it reduces the risk of heart attack more than it reduces stroke.

Should women take aspirin to help prevent heart disease?

Guidelines from the American Heart Association urge women to be more aggressive about cutting their heart disease and stroke risks. A daily aspirin can have a number of benefits for women.

A daily aspirin can: Women under age 65 Women age 65 and older
Prevent first stroke
Prevent first heart attack
Prevent second heart attack
Reduce heart disease risk

The guidelines recommend that women consider taking aspirin - which means have a discussion with your doctor about the risks and benefits of taking aspirin based on your own individual stroke and heart attack risk. The higher your risk of heart attack or stroke, the more that risk is reduced by taking aspirin, but the higher your risk is of bleeding.

In the feature on this site about what you could expect from simplehand.org we stated we would not offer any anecdotal material. I did not write all the above. I cribbed it from many places. It is all factual or it would not be offered.

Here is the most important thing you should take away from this feature: See your doctor regularly for the exact therapy and treatment you require. Remember, we are not doctors, we are only reporters.

The Simplified Handbook for
Living with Heart Disease
and Other Chronic Diseases

This comprehensive, doctor reviewed and approved book explains heart disease from a patientís perspective. Without complicated medical mumbo-jumbo, this blunt and hilarious book is a total lifesaver.