Understanding Differences in Men's and Women's Heart Disease
By Daisy Wakefield, Contributing Writer
In 2011, the American Heart Association reported that over 82 million Americans, one in four people, live with cardiovascular disease, which refers to a number of diseases that affect the heart and its surrounding blood vessels. Heart disease does not discriminate between men and women: for both sexes, heart disease causes more deaths than any other, contributing to about 26% of all deaths. Besides that, however, is there a gap between the sexes when it comes to heart disease, such as symptoms, treatment, and outcome? The similarities are there, but so are the differences.
Among both men and women, smoking, high cholesterol, high blood pressure, an inactive lifestyle, obesity, diabetes, stress, family history all contribute to an increase in risk of
heart disease.
Dr. Kevin Bybee, Cardiologist at St. Luke's Mid-America Heart Institute, says, "Typical risk factors put men and women both at increased risk, but women are at higher risk than men with similar factors."
The typical age when heart disease occurs is a key difference between men and women. The risk of heart attack increases after age 45 in men, but after age 55 in women. This may be because the female hormone estrogen provides some protection against heart disease in women; but estrogen decreases after menopause, which in turn increases the risk of heart disease. And yet, replacing estrogen in women after menopause does not protect against heart disease and may actually increase risk.
In men, studies have shown that the higher the level of the male hormone testosterone, the lower the risk of heart disease and vice versa. A class of drugs for treatment of prostate cancer does decrease testosterone levels, which may lead to an increase in heart disease risk. It is unknown if men with low levels of testosterone benefit from testosterone replacement when it comes to reducing heart disease risk.
Symptoms differ among the types of heart diseases, but with regard to heart attacks, the symptoms between the sexes can look
very different.
"Men tend to have the classic symptoms of heart attack," says Bybee, "like chest pain, especially on the left side, pain up to the jaw and down the arm. Women, however, experience symptoms like indigestion, shortness of breath, sweatiness, and fatigue. Women's heart attacks are sometimes misdiagnosed as other illnesses because they don't experience the typical heart
attack symptoms."
Women's symptoms may also be present for weeks before their heart attack. In fact, 95% of women who experienced heart attacks reported that they felt symptoms for up to a month before the attack.
 Along with higher rates of being misdiagnosed, women typically receive less treatment. After a heart attack, women are less likely than men to receive drugs known to improve survival.
Perhaps as a result, more women than men will likely have a second heart attack or die five years after a first heart attack: for women between ages 45-64, it is 50%
more likely.
Cherie Boxberger, Quality Improvement Director of the American Heart Association, says, "Historically, men have been the subjects of the research done to understand heart disease and stroke, which has been the basis for treatment guidelines and programs. Because women have been largely ignored as a specific group, their awareness of their risk of this often-preventable disease
has suffered."
Preventing heart disease runs along the same lines for men and women: stop smoking, maintain a healthy weight, monitor blood pressure and cholesterol numbers, be active, eat healthily, and limit alcohol drinking.
The difference comes in with the use of daily aspirin, which has been shown to decrease rates of heart attack in men. For women, however, a daily aspirin reduces risk of stroke, but does not reduce risk of heart attack. However, taking a daily aspirin can cause bleeding in the stomach, so consult your doctor to see if the benefits of taking aspirin outweigh the risks.
Diagnosis of heart disease is made through different tests such as electrocardiograms (test of the heart's electrical activity), blood tests, stress tests, and angiograms (test of the blood flow in arteries). Generally speaking, women delay seeking diagnosis and treatment for heart disease for longer periods than men.
Misdiagnosis of heart disease in women may be partially due to how symptoms look different in women's hearts compared to men. In the example of coronary artery disease, doctors look for the buildup of plaque in the arteries surrounding the heart, comparing one section of the artery to another. Men's arteries tend to show clumpy deposits of plaque along the vessel walls, giving clear signs of where the artery is normal and where it is not. WomenÕs arteries, however, tend to develop a thin layer of plaque all through the length of the blood vessel wall, making buildup and potential disease harder to find.
With increasing risks, like obesity and hypertension (high blood pressure), heart disease in the United States has seen a dramatic rise over the past two decades. Boxberger recommends to get tested, "All regular cardiovascular screening tests, for men and women, should begin at age 20, except blood glucose measurements, which should begin at age 45. In families where there are many risk factors – including high blood cholesterol, diabetes and overweight – it is important to have younger children evaluated as well."
To protect yourself against heart disease, you can start by assessing your own risk today at Heart.org. Be sure to consult with your health care provider for information specific to your health condition.
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