Heart Disease and the Gender Gap

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Cardiologist Dr. Suresh Sharma Offers Tips on Women and Heart Health

Dr. Suresh Sharma

Considerable gains have been made in understanding heart disease in women but there is still work to do in making women themselves aware of the signs and symptoms of a heart attack and the importance of seeking prompt treatment.

Heart disease is the leading cause of death in both women and men; it is responsible for one in three deaths in both sexes. But beyond that fact lie key differences in how heart disease manifests in men and women. For decades, heart disease in men was the standard by which symptoms were evaluated, diagnoses made, and treatment recommended. “A heart attack was more likely to be recognized in men,” says cardiologist Suresh Sharma, “and women, particularly if they didn't present with classical symptoms like crushing chest pain, were less likely to be given immediate, potentially life-saving treatment. Thankfully, considerable gains have been made in understanding heart disease in women but there is still work to do in making women themselves aware of the signs and symptoms of a heart attack and the importance of seeking prompt treatment.”

The Gender Gap: Signs and Symptoms
The most common symptom of a heart attack is pain or pressure in the center of the chest that may radiate to the neck, jaw, or left arm. But some people – and more women than men – experience atypical symptoms, including shortness of breath, weakness, sweating, nausea or vomiting, dizziness, back pain, and extreme fatigue. Chest pain in women is sometimes described as sharp or burning rather than the more typical pressure; some women experience pain in the neck, jaw, or upper abdomen but not in the chest; and some women have a “silent heart attack” with no pain at all. Almost two-thirds of women who die suddenly of heart disease have no previous symptoms.

The Gender Gap: Age and Survivability
While women and men suffer from heart disease in equal numbers, heart attacks strike men at younger ages. “We don't know exactly why men tend to be struck earlier than women,” says Dr. Sharma, “but we do know that women are more at risk for atherosclerotic cardiovascular disease after menopause. A likely explanation for this could be beneficial physiological effect of estrogen on vascular function in premenopausal women.”

The fact that women tend to be older and have more health problems at the time of a first heart attack may be a factor in explaining why fewer women than men survive a first heart attack. But another factor may be revealed in a study of 50,000 people over the age of 65 who were hospitalized for heart disease: Women were less likely to be treated with aspirin or cholesterol-lowering drugs or given advice on lifestyle changes, like quitting smoking. In another 2016 study, it was found that within five years of a first heart attack, 47% of women will die, develop heart failure, or have a stroke, compared to 36% of men.

The Gender Gap: Risk Factors
The most critical risk factors for heart disease – in both men and women – are high blood pressure, high LDL cholesterol, diabetes mellitus and smoking. Additional risk factors include obesity, inactivity, and poor diet. But there are differences in the degree of risk in men and women. For example diabetes is more strongly associated with heart disease in women than in men, Women over age of 60 have higher prevalence of hypertension than in men and obesity has more impact on the development of coronary artery disease in women than in men.

The Gender Gap: Types of Heart Disease
Some heart conditions are more common in women than men. One is microvascular disease, which affects the small arteries of the heart. Another condition that occurs exclusively in women is stress-induced cardiomyopathy, also known as “broken heart syndrome,” which is characterized by sudden, intense chest pain and shortness of breath and may be misdiagnosed as a heart attack but is actually caused by a surge of hormones brought on by an emotionally stressful event. Both conditions can be treated with medication.

Take Care of Your Heart
“Much heart disease is preventable,” says Dr. Sharma. “You can't control your age, gender, genetic makeup or family history, but you can make lifestyle changes and take preventive steps that will reduce your risk.” His recommendations include:

  •     Quit smoking!
  •     Eat a balanced diet and maintain a healthy weight.
  •     Exercise moderately at least 30 minutes a day.
  •     Find healthy ways to reduce stress.
  •     Have regular checkups that test your blood pressure, blood sugar, and cholesterol. Make sure you know what these numbers mean and follow instructions conscientiously to keep them within a healthy range.

“Despite the gains made in the last decade, heart disease in women may still be under-diagnosed and, as a result, under-treated,” says Dr. Sharma. “Women must know and manage their risk, be alert to the signs and symptoms, and act on them promptly.”

Bio: Suresh Sharma, MD, is an interventional cardiologist with KentuckyOne Health Cardiology Associates.

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