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Heart disease affects men and women differently with regards to symptoms, diagnosis, and treatment. This article outlines how.

Heart disease can affect anyone in your life, including you. However, there are subtle differences among men and women with regards to causes, symptoms and treatment of heart disease. Let’s have a look at how the disease differs between the genders.

Warning: Coronary artery disease is different for men and women

Coronary artery disease develops when the blood vessels that provide blood and oxygen to the muscles of the heart – known as the coronary arteries – become narrow or blocked. This interferes with blood flow and can stimulate a cascade of events that ends up causing a blood clot and blocking blood flow, leading to a heart attack. There are several differences between men and women when it comes to coronary heart disease.

Symptoms of a heart attack are different for women

When experiencing a heart attack, men and women often present with different symptoms. When you visualize how people have heart attacks in movies (such as chest-clutching), it’s actually mainly related to men. Men usually experience heart attacks as a pain that starts on the left side of the body in either the chest or the arm. Men will describe this pain as crushing and debilitating.

Women, on the other hand, will usually experience a heart attack in the form of:

  • Tiredness. This means that even if you are not exerting yourself, you feel extremely tired and can’t sleep. Even doing a simple activity such as going upstairs can make you feel extremely tired.
  • Feeling short of breath. If you feel short of breath without exerting yourself for a period of time, see a doctor, particularly if it's accompanied by chest pain or feeling tired. You may also feel cold and clammy without any apparent reason. You should be careful if your shortness of breath gets worse when you lay down and improves when you get up.
  • Pain in the neck, back, or jaw. If you feel pain in any of these places, but it’s not in any specific muscle or joint and just generalized pain, you should go see a doctor. Pain can be in either arm. You should pay special attention to pain that goes from the the chest and spreads to the back. Also, some people may experience pain that occurs out of nowhere and may wake you up at night, or pain in the lower left side of their jaw.
Women tend to experience milder symptoms for about three to four weeks before they have a heart attack. While some women do experience pain, it is usually in their neck or jaw, or in one or both of their arms. As women often describe symptoms that are more in line with the flu or non-specific problems, they are much more likely to be misdiagnosed.

In fact, this is why women in their 70s who have their first heart attacks often end up dying as many of these early symptoms are either ignored or misdiagnosed. Compared to men, women are much more likely to pass away due to a heart attack.

Women have risk factors for heart disease that are not found in men

Having certain diseases increases your likelihood of developing heart disease. Some of these diseases are only present in women, including:

  • Endometriosis. Endometriosis increases the risk of developing coronary artery disease by a shocking 400 percent among women under the age of 40.
  • Polycystic ovary disease (PCOS).
  • Diabetes associated with pregnancy (gestational diabetes). 
  • High blood pressure associated with pregnancy. 

These are added to the list of typical risk factors that are present in both men and women which include a family history, smoking, obesity, high cholesterol, diabetes, and high blood pressure.

Women have their first attack when they are older

Compared to men, women have their first attack much later in life. This is because women have a hormone called estrogen that seems to offer protection from heart disease, at least until menopause at which time estrogen levels drop and the protection ceases to exist. Thus, while the average age for a women having a heart attack is 70, men will, on average, have their first heart attack at 66.

It can be harder to diagnose coronary artery disease in women

The gold standard for diagnosing coronary artery disease is through an X-ray known as an angiogram which helps find if there are any narrow arteries or blockage. However, coronary artery disease in women tends to affect smaller arteries, which is often not seen properly on an angiogram. In fact, many women that go get an angiogram tend to get the okay from their doctor because they can’t see any issues. These women can go on to develop coronary artery disease.

Women have worse experiences after heart attack

Studies have shown that women do worse after a heart attack compared to men as they usually require a longer hospital stay and are more likely to die before they even exit the hospital. This is largely attributed to the fact that women have more untreated risk factors including diabetes and high blood pressure. Finally, women are less likely to be given medication that prevents blood clots, which is why women are at a greater risk of developing a blood clot compared to men. Hence, women are more likely to have a second heart attack, compared to men, within one year after their first.

  • Milner, K. A., Vaccarino, V., Arnold, A. L., Funk, M., & Goldberg, R. J. (2004). Gender and age differences in chief complaints of acute myocardial infarction (Worcester Heart Attack Study). The American journal of cardiology, 93(5), 606-608.
  • Riedinger, M. S., Dracup, K. A., Brecht, M. L., Padilla, G., Sarna, L., & Ganz, P. A. (2001). Quality of life in patients with heart failure: do gender differences exist?. Heart & Lung: The Journal of Acute and Critical Care, 30(2), 105-116.
  • Moser, D. K., McKinley, S., Dracup, K., & Chung, M. L. (2005). Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms. Patient education and counseling, 56(1), 45-54.
  • Photo courtesy of SteadyHealth

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