Setting the Record Straight on Women and Heart Disease
We assume a lot about our heart health. When we’re young, it’s easy to pass heart disease off as something that afflicts only older generations. But it’s not always so. In fact, heart disease is becoming more common at younger ages due, in part, to climbing rates of diabetes and obesity. We know women with diabetes develop heart disease at younger ages. And all women have a higher chance of heart problems after menopause.
Heart disease is the No. 1 killer of men and women in the United States. Yet, many misunderstandings remain about how heart disease affects women. Learning about heart disease is one of the best ways women can protect their hearts. All told, 80 percent of heart disease and stroke events could be prevented through lifestyle changes. But women, in particular, are largely unaware of their personal risk or chance of getting heart disease.
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If you are a woman or care for one, keep these points in mind:
Heart disease is NOT only a man’s disease.
Coronary heart disease affects women and men alike, and women tend to have worse outcomes. For example, more women die of coronary artery disease than men and fewer women will survive a first heart attack. Women surviving a heart attack also tend to have longer hospital stays and higher risk of death while in the hospital.
Heart disease, not breast cancer, is the No. 1 killer of women.
On average, 1 in 3 women will develop heart disease at some point in their lifetime compared with 1 in 8 who will get breast cancer.
It can happen at any age.
While coronary heart disease is more likely to develop as we age, it also strikes younger women. For example, heart disease can happen in young women who have:
- pregnancy-related complications such as spontaneous coronary artery dissection (SCAD), a sudden tear in one of the heart’s blood vessels
- coronary vasospasm, an abrupt tightening and narrowing of the heart’s arteries
- premature narrowing of the heart’s arteries (atherosclerosis)
- familial hypercholesterolemia, a disorder passed down in families that causes dangerously high levels of LDL or “bad” cholesterol
You may not be as heart-healthy as you think.
Most women—a full 90 percent—have one or more risk factors for heart disease or stroke.
The good news is that many of these risk factors—high cholesterol, high blood pressure, being overweight, or smoking, for example—are modifiable. That means you can take steps to reduce your risk, such as giving up smoking, maintaining a healthy weight, finding ways to fit more activity into your life, and eating more fruit, vegetables and fish. There are also risk factors that affect only women.
Heart disease can look very different in men and women.
Men are more likely to develop the “classic” narrowing or blockage in the coronary arteries, the blood vessels that supply blood to the heart itself, which can be detected with standard testing. But women may not have the classic, obstructive blockages typically seen in men, yet they still have reduced blood flow to the heart or suffer a heart attack.
For a long time, when no obstructive lesion was seen, these women were told there was nothing wrong with their hearts. But we now know from research that this is not the case.
Symptoms of a heart attack can be and feel different, too.
For some women, the first sign of heart disease is a heart attack, heart failure or a problem with how the heart beats. Because coronary artery disease can be silent or subtle, knowing your risk factors now and as you get older is critical.
Not all treatments are equally given.
While there have been major advances in treating heart disease, women are less likely than men to receive potentially life-saving treatments.
Women are less likely to receive early aspirin, beta blockers and other guideline-recommended therapies. They are less likely to undergo reperfusion and other treatments, and less likely to be offered preventive advice about how to make heart-healthy lifestyle changes. Interventions, including stenting or bypass surgery, tend not to be used as aggressively in women. After a heart attack, women are also less likely to take part in cardiac rehabilitation, which can improve overall health, and prevent deaths and repeat heart attacks.
Published: February 2017
Editorial Team Lead: Gina Lundberg, MD, FACC
Medical Reviewer: Martha Gulati, MD, MS, FACC