Heart Disease Affects Women Differently: What We Can Do About It

• Heart disease is the leading cause of death among women in the United States.
• Women wait more than 30 percent longer than men to get to a hospital after first experiencing symptoms of a heart attack.
• Women are 50 percent more likely to be diagnosed incorrectly after a heart attack.
• Heart disease is preventable 80 percent of the time.

Despite the American Heart Association (AHA) stating that 1 in 3 women will die of heart disease and that there’s an increase in heart disease in women under age 55, there are still many disparities in how women pursue preventive measures and receive care.

For instance, women wait more than 30 percent longer than men to get to a hospital after first experiencing symptoms of a heart attack. Women are also 50 percent more likely to be diagnosed incorrectly after a heart attack.

“Heart disease is the No. 1 killer of both men and women in this country. I’d like all women to know that if you have a heart, you’re at risk, but the most important thing for all women to understand is that 80 percent of the time, heart disease is preventable,” Dr. Suzanne Steinbaum, DO, preventive cardiologist and national spokesperson for the AHA, told Healthline.

What drives these gender disparities? Experts say they’re caused by a few factors.

1. Lack of awareness

Dr. Elsa-Grace Giardina, director of the Center for Women’s Health in the Division of Cardiology at New York-Presbyterian/Columbia University Medical Center, says less than 60 percent of women recognize that heart disease is the leading cause of death among women.

“That statistic has improved over the last couple of decades, but it’s not where we need it to be. We need to do a better job of educating the general population. Even women who had a heart attack are more likely to think they will die from some form of cancer rather than heart disease — in particular, breast cancer, and to a lesser extent lung cancer,” Giardina told Healthline.

Steinbaum agrees, noting that the AHA and other organizations work to get the message out about the importance of prevention but need to do more.

“As often as women will say, ‘I’m going for my annual mammogram,’ I’m hoping all women will go for their annual heart checks, so we can prevent this disease from taking so many women’s lives and vitality,” said Steinbaum.

2. Differing symptoms from men

While men and women most often present with chest discomfort in the middle of the chest under the sternum, Giardina says women can experience more subtle signs of heart disease.

“If they are presenting with vague symptoms, it may not be that the physician immediately recognizes that those symptoms are associated with heart disease,” said Giardina. “Often, their symptoms can be misunderstood as gastrointestinal-related.”

Subtle signs women experience may include:

• shortness of breath
• nausea
• vomiting
• fatigue
• back pain
• sweating
• jaw pain

“When you are not aware of the symptoms being connected to a cardiac event, you don’t get to the emergency room in time and there is more likely to be damage to the heart muscle. If you don’t get appropriate therapy immediately, then that muscle is forever scarred and more likely to have heart failure or arrhythmias or recurring events,” said Giardina.

3. Lack of women in studies

In the 1980s, Giardina wrote a proposal to the National Institutes of Health (NIH) to study an aspect of cardiovascular disease in both women and men. Her proposal was rejected, and she still remembers the criticism from two of the three reviewers who wrote, “Why is the proportion of women so high in the study? Everybody knows that heart disease is a disease of men.”

Today, she says strides have been made and more women are included in studies.

“I think every medical school now in the cardiology rotations emphasizes that heart disease is the leading cause of death among women, but in those days, we believed that heart disease was a man’s disease even though the data didn’t indicate that; there were just as many women dying from heart disease than men, but there was so much research that focused on outcomes for men instead of women,” Giardina said.

Lacking behind in research studies means women still need to be caught up, says Steinbaum.

“It wasn’t until 1993 that the NIH made a statement that women need to be included in trials as much as men. What’s interesting is we get to the 2000s, and it didn’t really happen and the research wasn’t improving as much,” she said.

In the past 15 years, research for women finally started to become equal.

“Now, we have the American Heart Association having this educational initiative for women to really understand her heart disease risks, and they are also supporting research and science,” said Steinbaum.

4. Unconscious bias

Both Giardina and Steinbaum point to an unconscious bias that may contribute to gender disparities, though it can be complicated to pinpoint and talk about.

“There is a pervasive unspoken bias we know happens whether it’s because heart disease was never thought of as a women’s issue for so long or because women present differently, or possibly [because of the notion] that if you look good, it can’t be the heart [having issues]. We don’t know 100 percent what the answer is to that,” she said.

What can women do?

Family history of heart disease puts men and women at increased risk, and both genders need to practice the same lifestyle habits for heart health, including:

• not smoking
• drinking in moderation, as excess alcohol consumption can increase blood pressure
• exercising, which for women is a recommendation of moderate activity for 150 minutes a week
• maintaining a moderate weight
• getting adequate sleep, ideally 7 hours per night

However, Steinbaum adds that depression, which is more prevalent in women, also increases risk for heart disease.

“We are understanding that the brain-heart [connection] affects women’s hearts greater than it affects men’s,” said Steinbaum.

Additionally, Giardina says research is showing that women who have abnormalities associated with arthritis like systemic lupus or rheumatoid arthritis, which are associated with chronic inflammation, may be at greater risk for heart disease, as well as women who experience hypertension or gestational diabetes during pregnancy.

“If you had hypertension or gestational diabetes while pregnant, in your later years, you are at greater risk for developing coronary artery disease, and your children may be too at a later point in life,” said Giardina.

While it’s not known why these conditions put women at increased risk, she says it may have to do with changes that occur in the coronary arteries or in the endocrine system that predispose the women to coronary artery disease. Another thought is that the conditions change the arterial wall causing endothelial dysfunction.

“Or it may be that women who are predisposed to gestational abnormalities have something [different in] their endothelial function when young that may alert them to the possibility of future outcomes that are negative regarding cardiovascular disease. Someday we’ll find that out,” Giardina said.

In the meantime, Steinbaum says make it a point to see your doctor.

“Going for a well visit where you can get screened for the markers of heart disease with a physician is important. Prevention begins there,” she said.

If you’ve already experienced a cardiac event, Steinbaum says not to focus on the guilt and instead think about what you can do to get healthy.

“I find that with something like breast cancer, we use terms like survivor. With heart disease, a lot of women feel guilty that they [did this to themselves],” she said. “We’re all not perfect. Develop a relationship with your doctor, advocate for yourself, and make lifestyle [changes].”

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Cathy Cassata is a freelance writer who specializes in stories about health, mental health, and human behavior. She has a knack for writing with emotion and connecting with readers in an insightful and engaging way. Read more of her work here.

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