Heart disease is the number one killer of women in the U.S. Yet heart disease in women remains under-diagnosed. A 2018 study from the University of Leeds in the U.K. found that a woman was half as likely as a man to have her heart attack diagnosed correctly on her first trip to the ER.
Why is that? The National Institutes of Health offers a twofold answer: First, even medical professionals assume that cardiovascular disease just isn’t very much of a threat for women. Second, women can experience different, less obvious heart attack symptoms from men. Women’s underlying risk factors may be different, too.
To combat these misconceptions and to empower women to take charge of their own heart health, the American Heart Association launched a campaign called “Go Red for Women.” On February 7th this year, people across the country will wear red to raise awareness for heart disease. Join the cause and learn the signs of heart disease in women. You might just save a life (including your own).
A Woman’s Heart Attack Might Not Look Like One
Heart attacks usually come from a buildup of plaque within the coronary artery. Over time, this buildup restricts blood flow. Your cardiac muscle cells start to die. As the flow of blood to your heart gets interrupted, you feel it. It’s uncomfortable. Eventually, that buildup leads to a condition called atherosclerosis. Heart attacks happen for other reasons, too, but plaque buildup is the typical culprit.
The most common heart attack symptom in both sexes is chest pain. Women, however, are more likely to describe this sensation as pressure or tightness. Women are also far more likely than men to experience less obvious heart attack symptoms, like:
- Discomfort that feels more like indigestion or gas
- Weakness and fatigue
- A sense of impending doom
Men tend to feel heart attack symptoms during activity. Women may feel them at rest or while sleeping. Heart attack symptoms don’t get better or change with different positions like regular muscle pain.
Women’s Risk Factors for Heart Attacks Differ from Men’s
Cardiac risk factors for women also differ. The three leading risk factors for cardiac disease are high blood pressure, high cholesterol and obesity. These factors seem to affect men and women equally. But other factors are specific to women or affect women at higher rates. These include diabetes, smoking, menopause, pregnancy, inflammatory disease and depression.
Diabetic women are twice as likely as diabetic men to develop heart disease. Diabetic women also tend to have heart attacks earlier in life. This is particularly striking because in general, cardiovascular disease develops 7 to 10 years earlier in men.
Heart attacks in women with diabetes are more likely to be fatal, too. This may be due in part to the attitudes of doctors. Women are 10% less likely to be prescribed cholesterol-lowering medications in the year after they’re first diagnosed.
The heart attack rate among female smokers is 25% higher than it is among male smokers, according to 2011 research published in The Lancet. Even when a woman quits smoking, her risk of developing heart disease remains higher compared to a man who quits at the same time.
Medical scientists believe that estrogen protects arteries and other blood vessels by keeping the inner linings supple and flexible. Menopause brings a significant drop in women’s estrogen levels. As a result, menopausal women may face a higher risk of heart disease.
Gestational diabetes and high blood pressure can make women more likely to develop heart disease.
Inflammation boosts cardiac risk by promoting the growth of plaque inside blood vessels. Inflammation is part of the body’s normal immune response. But in some cases, the body’s defense system triggers inflammatory responses in the absence of pathogens.
In other words, your body might start fighting infections that aren’t there. Inflammatory diseases like rheumatoid arthritis and lupus are far more prevalent among women than men. These conditions can increase the risk for heart disease.
Stress and depression affect the female heart more than the male one. Some research suggests that the presence of depression can actually be used to predict which women will develop heart disease later in life.
Both physiological and behavioral factors seem to be involved here. Depression creates a perfect storm of heart disease risk factors.You may not take care of yourself if you’re depressed. Lack of physical activity, smoking, a bad diet and general neglect can all play a role in heart disease.
Depression also boosts the production of adrenaline, cortisol and norepinephrine, stress hormones that drive the body’s “fight or flight” response. These hormones cause spikes in breathing, heart rate and blood pressure. And while these spikes make sense during a crisis, they can damage your heart if they happen for too long or too often.
In rare cases, stress triggers a reaction called stress-induced cardiomyopathy, or broken heart syndrome. This happens far more often to women than it does to men. It’s not a heart attack per se. But if left untreated, it can lead to failure of the cardiac muscle.
Don’t Wait to Find Out If It’s a Heart Attack
According to the American Heart Association, one reason why symptoms may present so differently between the sexes is underlying pathophysiology. In men, larger arteries tend to get blocked. Women are more likely to develop coronary microvascular disease, or blockages in the smaller arteries.
Women also tend to wait too long to see a doctor for symptoms they don’t recognize as heart attack signs. By the time they get to the ER, serious damage to the heart may already have happened.
If you think you may be having a heart attack, seek medical attention right away. Call 911 and do not drive yourself to the hospital.
Don’t wait it out or guess when it comes to chest pain or tightness. You’re at high risk for developing a fatal arrhythmia. You need to be in a medical environment where you have access to trained staff, equipment and proper medications.