Matters of the Heart 4 Ways Women’s Heart Health Differs From Men’s
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When it comes to heart disease, men and women are not equal. Most of what we know about heart disease, and how we approach it today, is still largely based on research studies that originally focused on men. Not long ago, researchers assumed their study insights would apply to women as well. But newer studies are showing us that women’s heart health—and how women develop and experience heart problems—can be much different than that of men. Additional research is under way, at MedStar Health and other centers, but here are a few learnings that women and their doctors should know now.

1. A woman’s heart is physically different than a man’s.

In general, women have smaller hearts and blood vessels. In addition, women tend to develop plaques (waxy substances) in their vessels that look and behave differently than the build-ups and blockages we typically see in men.

This could make women more likely to develop different kinds of heart trouble than men usually experience. In particular, we think women may be more prone to developing coronary microvascular disease, in which damage to the inner walls of the smaller blood vessels can lead to spasms and decreased flow of blood and oxygen to the heart muscle.

Both arterial blockages that are more common in men and small-vessel coronary disease are serious and can cause the same symptoms, including chest pain and shortness of breath. The latter can be harder to detect with traditional tests.

2. Women may need different diagnostic tests than men.

Doctors often recommend a stress test and sometimes an imaging study called a coronary angiography to diagnose classic symptoms of heart trouble. While these are good at finding blockages in the large coronary arteries, they aren’t necessarily designed to detect the coronary microvascular disease that women are more apt to have.  So their symptoms may be dismissed.

If you continue to experience chest pain or shortness of breath after tests like these come back as “normal” or “nothing to worry about,” consider getting a second opinion. Choose a cardiologist who specializes in women’s heart health or is otherwise part of a specialty heart center, like MedStar Heart & Vascular Institute.  Other diagnostic tests, such as a cardiac PET scan or cardiac MRI, may be needed. These specialized tests are not available everywhere.

3. Women’s heart attack symptoms are often different than men’s.

Severe chest pain can be a sign of heart attack in both men and women. But women are much more likely to have subtle symptoms that are easier to ignore. These include:

  • Chest discomfort that travels to your arms, neck, or upper back
  • Sudden shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Extreme fatigue
  • Indigestion

If you experience signs like these, don’t hesitate to call 911 and get to an emergency room. Fast action can prevent extensive heart damage and even save your life.

4. Women have unique risk factors for heart disease.

Both sexes share the most common risk factors, including high blood pressure, high cholesterol, obesity, and type 2 diabetes. Women, however, have additional risk factors that men never or less commonly experience. Be sure to tell your doctors if you’ve had any of the following, so they closely monitor your heart health:

Early menopause: A recent study found that women who reached menopause earlier than age 50 had an up to 40% greater risk for cardiovascular disease than women who became menopausal in their early 50s, as is most common. A drop in the heart-protective hormone estrogen that occurs with menopause probably explains some of this elevated risk.

Chronic inflammatory diseases: Women are more likely to have many of these conditions, including lupus, psoriasis, and rheumatoid arthritis, which also raise the risk for heart disease. Ongoing low-level inflammation can irritate the blood vessels and may promote plaques and blood clots that can put the heart and vessels at risk.

Breast cancer treatment: Women (and men) who have undergone radiation or chemotherapy treatment to the breast area may experience more heart problems as a byproduct of these treatments. A recent study also found that women who have had breast cancer were also more likely to develop other conditions that increase heart risks, including diabetes, high triglyceride levels (fatty molecules in the blood), and atherosclerosis (stiffening of the arteries).

Pre-eclampsia: An estimated 6%–10% of women develop this dangerous increase in blood pressure late in pregnancy, which significantly increases the risk for hypertension, heart disease, and stroke later in life, even if their blood pressure returns to normal after delivery. 

When it comes to heart disease, men and women are not equal. Dr. Barbara Srichai explains. via @MedStarWHC

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How to Keep Your Heart Healthy

  • Quit smoking or don’t start
  • Get regular exercise. At a minimum, walk around at least 30 minutes per day 
  • Eat healthy, including plenty of fruits, vegetables, whole grains, and fish or lean meat. Limit processed foods, salt, added sugars, and saturated and trans fats 
  • Know your numbers. Maintain a healthy weight, blood pressure, cholesterol, and blood sugar level through lifestyle and any medicines your doctor has recommended 
  • Limit your alcohol to no more than one drink per day

Learn more by taking our women’s heart disease risk quiz.

Questions about your heart?

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