Decoding the Differences: Heart Attacks in Men and Women
Discrepancies in Heart Disease in Men and Women
Heart disease remains a leading cause of death worldwide, affecting both men and women. However, the manifestation, progression, and treatment of heart disease are not identical across the sexes. Over the past decade, heart disease, especially among young women, has seen an alarming increase. Despite this, women’s heart disease conditions are often misdiagnosed, and their treatments are regularly delayed. This is partly due to the lack of sufficient representation of women in heart disease studies. In fact, only about 30% of study subjects are women, leading to guidelines primarily based on male data.
The Biological Differences
Men and women differ significantly in their anatomy and physiology. This extends to their cardiovascular systems as well. Women tend to have smaller hearts and narrower blood vessels compared to men. This difference in biological features leads to heart disease progressing differently in women compared to men. Women are more likely to develop cholesterol plaque buildup in the smallest blood vessels of the heart, known as the microvasculature, while men typically develop this buildup in the largest arteries that supply blood to the heart.
Varying Symptoms of Heart Attacks
Men are more likely to experience the classic chest pain associated with heart attacks. On the other hand, women’s symptoms tend to be more atypical, including shortness of breath, nausea, and fatigue. Women do experience chest pressure, the leading complaint, but they are more likely than men to also report nausea, sweating, vomiting, pain in the neck, jaw, throat, abdomen, or back. These differences may lead to misdiagnosis, with women’s heart disease often being categorized as gastrointestinal problems or anxiety.
Higher Risk Factors in Women
A woman’s reproductive history may affect her risk of developing heart disease. Certain diseases that develop during pregnancy, such as preeclampsia and gestational diabetes, may be powerful predictors of future risk of heart disease. A study showed that women age 40 or younger with endometriosis were three times more likely to develop heart attack, chest pain, or require treatment for blocked arteries compared to women without endometriosis in the same age group. Despite this, only about 10% of women diagnosed with pregnancy-related heart disease see a doctor, let alone a cardiologist, about the condition.
Diagnostic Care and Treatment Differences
When a woman presents with signs and symptoms of a heart attack, they may receive different diagnostic care than a man. A common test is the cardiac troponin (cTn) test, which measures circulating levels of troponin, a protein released in the blood when a heart attack has damaged heart muscle. However, the clinical threshold that signals a heart attack may differ across the sexes. Some women may be having a heart attack but are falling below the level of detection. Women are more likely than men to suffer from diseases that mimic a heart attack, further complicating diagnosis.
Medical providers are beginning to approach treatment decisions with the knowledge that women may benefit from treatments that are different from those used in men. This could include subtle calibrations in pacemakers to variations on angioplasty. However, this understanding is still developing, and more clinical trials are needed to fully inform clinicians about potential treatment differences.
Increased Risk of Heart Failure in Women
Women face a 20% increased risk of developing heart failure or dying within five years after their first severe heart attack compared with men, according to research published in the American Heart Association’s flagship journal Circulation. This increased risk in women could be attributed to a variety of factors, including women being generally older at the time of their heart attacks and having a more complicated medical history. Women also have more risk factors that may contribute to heart failure, such as high blood pressure, diabetes, atrial fibrillation, and chronic obstructive pulmonary disease.
Prevention and Control
Regardless of the disparities, the good news is that up to 90% of heart disease cases can be prevented with healthier lifestyle choices. These include nutritious dietary choices, increased physical activity, healthy sleep habits, quitting smoking, and regular appointments with your doctor. Reducing stress, especially during high-stress events like the current pandemic, is also crucial as chronic high levels of stress are bad for heart health.
It is essential for women to familiarize themselves with the signs and symptoms of a heart attack and ask their physician to assess their risk of heart disease. Women with endometriosis, preeclampsia, or gestational diabetes should adopt heart-healthy lifestyle habits. Regular check-ups and follow-ups with doctors are also crucial to prevent heart disease before it develops.
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