Cardiovascular Disease Is Different for Women

More women are aware of cardiovascular disease and its symptoms, thanks to national campaigns such as the American Heart Association’s Go Red.

“At the same time, many don’t know that cardiovascular disease is the leading cause of death in women in the United States,” says physician Ewa Gross, MD, PhD, Director of UH's Women’s Cardiovascular Center.

“Many people don’t realize that cardiovascular disease is a bigger threat to women than cancer,” she says.

Consider these statistics:

• In the United States, about 3.3 million women are living with breast cancer, while cardiovascular disease affects 48 million women.
• About 40,000 women die from breast cancer every year; cardiovascular disease kills 400,000 every year.

Women and Cardiovascular Disease: Highlights

Symptoms, treatment and outcomes of cardiovascular disease are all different for women, Dr. Gross says. For example:

• Women tend to be diagnosed later with cardiovascular disease than men.
• Women tend to fare worse than men after a heart attack.
• Women have heart attack risk factors that men don’t have, such as polycystic ovary syndrome, pregnancy-related hypertension, pregnancy-related diabetes, and early menopause.
• Women who smoke are at greater risk of developing a heart attack than men who smoke.
• Women are generally older at the time of their first heart attack.
• Women have different and lesser-recognized heart attack symptoms than men.
• Women are more likely than men to die in the first 12 months after a heart attack.

“There are varying reasons for these differences,” Dr. Gross says. Men and women’s hearts have the same coronary anatomy and architecture, but differ significantly in how cardiovascular blockages develop.

For example, while men tend to develop blockages in the large arteries, women tend to develop fatty plaque buildup more evenly throughout their arteries, which affects the smaller, narrower arteries that are embedded in the heart muscles.

“In women, heart disease usually affects small arteries, so it’s hard to see them on angiograms,” Dr. Gross says. “This is why many times women will report symptoms, but blockages are not seen.”

Other reasons for gender differences may be that some women lack access to the best treatment for their disease. Other women may not know they are at risk until it is too late.

Heart Attack Symptoms Different, Too

“Two-thirds of women will experience a heart attack differently than men,” Dr. Gross says.

A heart attack happens when the blood flow that brings oxygen to the heart is severely reduced or cut off completely.

Rather than experiencing the widely known symptoms of chest pain or pressure, a woman may instead experience shortness of breath, pressure or pain in the lower chest or upper abdomen nausea, dizziness, lightheadedness, a feeling of faintness, upper back pressure or extreme fatigue.

Women often will chalk up the symptoms to less life-threatening conditions like acid reflux, the flu or normal aging – and so fail to seek medical help.

“Even some doctors may not alert to these symptoms indicating a heart attack,” Dr. Gross says. She advises that women speak up about the possibility of a heart attack when reporting these symptoms to a physician.

Tell the physician: “I just want to make sure it’s not my heart,” Dr. Gross says.

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