Why women’s heart disease is different to men’s
By Jean Hailes Nurse Educator Rhonda Garad
Heart disease is still the number one killer of women, with one in three of us affected. This is disturbing but not new information. However, what is new are some interesting answers to questions that have for a long time intrigued health professionals and researchers. Questions such as: why are women more at risk of heart disease after menopause and why do we experience different symptoms of a heart attack than men? Thankfully we now have, for the first time, some really interesting answers with research venturing into the brave new frontier of gender-specific medicine.
Heart attack symptoms for women
The most common heart attack symptom in women is not the typical crushing chest pain radiating down the left arm. It is more likely to be some type of pain, pressure or discomfort in the chest. But it’s not always severe or even the most prominent symptom, particularly in women. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:
- Neck, shoulder, upper back or abdominal discomfort
- Indigestion-like symptoms
- Shortness of breath
- Nausea or vomiting
- Light-headedness or dizziness
- Unusual or extreme fatigue, as though you have been hit by a bus
Women at higher risk of long-term heart damage
Research shows women are far more concerned about heart attacks for the men in their lives than themselves. This belies the reality that after menopause we are at equal risk as men. This perception, that we are at low risk, places us at greater risk of ignoring one when it happens. Women are often unaware they are experiencing a heart attack and may not get help immediately, resulting in greater heart damage. Being aware of how women experience heart attacks may just save a life – either yours or someone you care about.
Heart disease risk factors for women
We have been taught to be aware of, and avoid, the traditional risk factors for heart disease such as high cholesterol, high blood pressure and obesity, which affect both men and women. But we now know that other factors may be as important for women, including:
- Metabolic syndrome – a cluster of conditions that often occur together such as fat around your abdomen, high blood pressure, high blood sugar and high cholesterol
- Mental stress and depression
- Smoking is a greater risk factor for heart disease in women than in men
- Low levels of oestrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease)
What you can do for yourself
There are several lifestyle changes you can make to reduce your risk of heart disease:
- Exercise for 30-60 minutes a day, on most days of the week
- Maintain a healthy weight
- Quit smoking
- Eat a diet low in saturated fat, cholesterol and salt
- Take prescribed medication
- Work on strengthening your reaction to stress
- Change situations that cause you a great deal of stress
There is new evidence of the protective role of oestrogen, which explains why our risk of heart disease and stoke increases after menopause as our oestrogen levels decline.
Associate Professor Chris Sobey from Monash University believes that oestrogen holds the key to improving the outcomes in women after a stroke. The Monash team has found that activating an oestrogen receptor in women who have had a stroke improves their recovery. However, conversely, when they activate the same receptor in men, they show worse outcomes.
This ground-breaking finding is based on a new understanding that men and women are different right down to the cellular level. Women, it seems, show different susceptibility to disease than men. For example, non-smoking women are three times more susceptible to lung cancer that men, but if they receive appropriate care, show better survival rates.
In addition, women may need different investigations for diseases such as heart disease. It seems that heart disease in men is more visible, such as a blockage, on standard investigations. However, women lay down plaque within the arteries more evenly and therefore need investigations that are more sensitive, such as an intra-coronary ultrasound.
This can be critical information that can save a women’s life.
One of the reasons we don’t know a lot about effective treatments for women is that drug trials do not separate data between men and women. This leaves us none the wiser about the different responses between the sexes and therefore which treatments are more effective for women.
This new and emerging era of personalised medicine, including differences between men and women, promises exciting new insights and effective treatments for women. And it will also broaden our understanding of women’s health.