Heart Disease in Women: How Gender-Related Differences Impact a Woman’s Heart
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Heart failure is a common cardiac diagnosis and one of the leading causes of hospitalization in the United States. You may be surprised to learn that there are gender differences in heart failure, from its incidence, hospitalization rates, causes, and how and when it is diagnosed. Knowing these differences is important so you know what to look for when it comes to heart failure and how to lower your risk of the potentially life-threatening condition.


Women are more likely to develop specific types of heart failure.

Heart failure is a lifelong or chronic condition in which the heart muscle can’t pump enough blood to meet the body’s needs for blood and oxygen. Essentially, the heart can’t keep up with the body’s workload. Heart failure can occur when the heart muscle is weaker or stiffer than should be. 

The most common cause of heart failure in men is coronary artery disease, which is blockage in arteries that leads to a weakened heart. In contrast, the most common cause of heart failure in women is high blood pressure and diabetes, as the heart stiffens (diastolic heart failure). There are several gender-specific factors that can impact a woman’s susceptibility to developing high blood pressure that leads to heart failure, from her physical anatomy to her age and hormone levels. 


Women are also more likely to develop heart failure with preserved ejection fraction, or diastolic dysfunction, which occurs when the squeeze function of the heart is normal but the heart becomes stiff with age. Takotsubo, commonly known as broken heart syndrome, is also more common in women. This acute type of a weak heart can occur after a stressful or traumatic event like the death of a loved one.

In addition, peripartum cardiomyopathy is a type of heart failure unique to women. It’s a dysfunction of the heart muscle that occurs late in pregnancy or a few months after the delivery. A lot of the symptoms of heart failure can mimic symptoms of normal pregnancy, such as shortness of breath, bloating, and leg swelling. Early diagnosis is critical to intervene before the condition progresses, as it can lead to electrical problems in the heart (arrhythmia), clotting problems, or even death. 


A woman’s heart is physiologically different from men's.

Generally speaking, the left ventricular mass in a woman’s heart is smaller than a man's. Women also tend to have thinner walls in the right and left ventricles of the heart. In addition, the arteries that supply blood to the heart muscle (coronary arteries) are usually smaller and thinner in women than in men. And, the secondary and tertiary vessels going to the heart are sometimes smaller or fewer in number in women than in men. All of these physiological differences can impact blood flow and make a woman more susceptible to heart damage as a result of high blood pressure or minor coronary artery disease. 


Estrogen and other factors that impact a woman’s risk of heart failure.

Risk factors for heart failure are similar for men and women and include obesity, smoking, family history of heart disease, and having other related conditions, such as coronary artery disease, obstructive sleep apnea, high blood pressure, and diabetes. An individual’s risk of heart failure increases with age, although men seem to develop heart disease earlier than women. That’s because up until menopause, women seem to be somewhat protected by estrogen.

Estrogen is a natural hormone present that can protect women from heart disease by preventing inflammation that can cause plaque buildup. However, starting in their 40s, women begin to experience decreased levels of estrogen as they approach menopause. As estrogen levels go down, blood pressure can rise, increasing a woman’s risk of developing heart failure. 

In addition, estrogen is important for handling insulin. When estrogen levels decrease, it can lead to small changes in glucose levels, which can add to the risk of coronary artery disease and heart failure. Estrogen is also useful for controlling lipid levels, so women may experience changes to their cholesterol during and after menopause. All of these changes can elevate a woman’s risk of developing high blood pressure or heart failure.


The warning signs of heart failure in women may differ from men.

Because men tend to have more coronary artery disease, they tend to experience chest discomfort or trouble breathing. It’s important to know that women can also develop this type of heart failure and therefore experience the same symptoms. However, women may be more likely to experience more subtle symptoms of heart disease, such as:

  • Difficulty lying flat
  • Shortness of breath at rest or during activity
  • Swelling in legs or abdomen
  • Feeling full after eating small meals

Some symptoms may be more prominent in certain individuals than others. Because many of these warning signs may mimic symptoms of other conditions, it’s always critical that you talk to your doctor to identify the underlying cause of your symptoms.


Considerations for preventing and treating heart failure in women.

If you have heart disease or a related heart condition, you can minimize your risk of developing heart failure by:


  • Adhering to prescribed medications
  • Managing any chronic illnesses, such as diabetes
  • Following a heart-healthy diet
  • Controlling your weight
  • Avoiding tobacco use

If your doctor suspects signs of heart failure, they’ll evaluate your medical history, family history, physical condition, and various tests to identify any areas of concern in the heart. Because women tend to have smaller hearts, values considered “normal” may differ from what is normal for men. In addition, breast tissue can cast a shadow over the heart which can make it harder to interpret some imaging tests. At MedStar Health, your doctors are experts in performing and interpreting these tests, and we‘ll help you understand your results so you can make the best decisions about treatment.


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Treatments for heart failure are better than they ever have been, leading to exceptional outcomes for many patients.

Heart failure treatment varies based on the type and cause, regardless of gender. Patients with weak hearts (systolic heart failure) may be advised to take a combination of four medications, which is proven to lead to the best outcomes, including less hospitalization, longer lives, and stronger hearts. Men and women who experience heart failure with strong hearts (diastolic heart failure) may benefit from a class of medicine called SGLT-2 inhibitors, which has been shown to improve morbidity and mortality. Because women have a lower blood volume and filtrate rate in the kidneys, it’s important for doctors to evaluate each individual patient to optimize their medication dosage based on how they’re responding to treatment. If medications are no longer working or patients aren’t tolerating them well, your doctor may recommend heart surgery. 

Heart failure is a serious condition for both genders. Knowing your own risk factors and monitoring yourself for early signs is critical for early intervention which leads to better outcomes. If you are at risk for heart disease, our advanced heart failure cardiologists can help.


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