9 Physical and Emotional Ways Heart Disease Is Different for Women

Heart disease is the number-one killer of women (and men) in America, but men are more likely to be diagnosed and women are more likely to die. Here, why heart symptoms, red flags, risk factors, and treatments can be different for women, and what you can to reduce your risk.

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Heart attack symptoms can be more subtle

Heart attack symptoms can be more subtleiStock/Patrick Heagney
“Although men and women can experience chest pressure that feels like an elephant sitting across the chest, women can experience a heart attack without chest pressure, ” Nieca Goldberg, MD, medical director for the Joan H. Tisch Center for Women's Health at NYU’s Langone Medical Center, told the American Heart Association. “Instead they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue.” Even though heart disease is the number-one killer of women in America, women don’t always immediately suspect heart attack when some or all of these symptoms strike. They may mistake them for acid reflux, the flu, or normal aging, according to the AHA.

Women may have a different type of heart disease

Women may have a different type of heart disease iStock/aykuterd
Part of the reason heart attack symptoms can present differently in women is because there’s a difference in plaque and blockage patterns between men and women, according to cardiologist C. Noel Bairey Merz, MD, director of the Women’s Heart Center at the Cedars-Sinai Heart Institute. On the center’s website, Dr. Bairey Merz explains that women’s heart disease should be called ischemic heart disease, which indicates a lack of blood flow and oxygen to the heart. (The kind of heart disease that primarily affects men should remain coronary artery disease, which indicates plaque build-up in the arteries near the heart). “Women with ischemic heart disease generally have major arteries that are clear of plaque, but the smaller coronary blood vessels cease to constrict and dilate properly, creating the lack of blood flow and oxygen to the heart,” according to the site. Women can have normal angiograms and stress tests even if they have ischemic heart disease; doctors should pay attention to symptoms like chest pain and shortness of breath instead of just looking at test results, Dr. Bairey Merz says.

Female heart attack patients take longer to get to the hospital

Female heart attack patients take longer to get to the hospitaliStock/Leonardo Patrizi
Seventy percent of women having a heart attack took longer than an hour to get to a hospital, according to a 2015 European study of 7,400 heart attack patients. Only 30 percent of men with heart attack symptoms took as long, HealthDay reported. A main reason for the delay: Women took longer to call for help than men did. "Our findings should set off an alarm for women, who may not understand their personal risk of heart disease and may take more time to realize they are having a heart attack and need urgent medical help," study author Raffaele Bugiardini, a professor of cardiology at the University of Bologna in Italy, said in a press release.

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Everyday stress can affect women's hearts more

Everyday stress can affect women's hearts moreiStock/Poike
In a recent Duke University study, men and women with heart disease performed stressful tasks while researchers studied their heart functions. Fifty-seven percent of the women experienced reduced blood flow to their hearts during stressful times compared with 41 percent of the men. Blood platelet clumping, which can lead to a heart attack, was also more prevalent in stressed women than in stressed men, a finding researchers say could help tailor blood-thinning treatment for more effective use in women.

Women need to take sleep apnea seriously

Women need to take sleep apnea seriouslyiStock/Juanmonino
Although sleep apnea is associated with heart disease in both men and women, the sleep disorder may negatively affect the heart rates of women more than those of men, according to recent research. During various physical challenges, the heart rates of sleep apnea patients didn’t change as much or as quickly as the rates of healthy adults (a sign of greater cardiovascular disease risk). The effect was even more pronounced in the women. Researchers plan to study whether treating sleep apnea with CPAP therapy improves patients’ heart rate function.

A baby’s birthdate can provide a clue about women’s heart health

A baby’s birthdate can provide a clue about women’s heart healthiStock/DNF-Style
Women who experience spontaneous preterm delivery (before 37 weeks) may have a greater likelihood of heart disease, according to a new Dutch study. Moms of preemies had a 38 percent higher risk of coronary artery disease, a 71 percent higher risk of stroke, and more than double the risk of overall heart disease. Researchers say these women may be prone to inflammation, which is linked to preterm delivery and common among heart disease patients.

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So can the timing of menopause

So can the timing of menopauseiStock/CaseyHillPhoto
University of Alabama, Birmingham research found that women who enter menopause early (before age 46) may have double the risk for a heart attack or stroke, Woman’s Day reported. “Experts suspect that if you stop ovulating prematurely, this may be a sign of blood vessel disease, and you may need extra screenings,” according to the magazine.

Doctors may be less likely to discuss women’s heart risks

Doctors may be less likely to discuss women’s heart risksiStock/fotostorm
Women under 55 are more likely to experience a fatal heart attack than men but were 11 percent less likely to report being informed of their risk before a heart attack in a new Journal of the American College of Cardiology study. The women were 16 percent less likely to report discussing risk reduction with a health-care provider. Ask a doctor about your odds and the influence of gender. Diabetes, for example, has greater effects on risk in women.

Implanted defibrillators may not work as well in women

Implanted defibrillators may not work as well in womeniStock/mediaphotos
Women heart disease patients who get an implantable cardioverter defibrillator (ICD) are likelier than men to have complications and an increased risk of death, according to 2012 research on nearly 39,000 patients, 25 percent of whom were women. (ICDs help maintain a normal heart rhythm by sending out electrical pulses if an abnormal rhythm is detected). One reason for the gender discrepancy may be that female patients may be in worse condition (older age, more severe stages of disease, other coexisting conditions, etc.) when they have the devices implanted.

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Simple Ways to Slash Your Heart Disease Risk

It starts with diet. Eat these heart-healthy foods numerous studies have shown can help you avoid clogged arteries. Getting more physically active is key, but you don’t need to become a gym rat. Here’s how integrative cardiologist Joel K. Kahn, MD, motivates his patients to get more active. Plus, make time to laugh, cuddle, and embrace these positive emotions: Science has basically proven they can make your arteries healthier and reduce your heart disease risk. Finally, ask your doctor about these cutting-edge tests that can detect silent symptoms of heart disease.

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