Heart Disease in Women : What We Know Now

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Heart disease is a major health concern across the country, affecting more than 500,000 women each year. While science has made progress in diagnosing and treating female heart issues, research is still ongoing.

In this article, we’ll discuss the intricacies of heart conditions in women, exploring symptoms and shedding light on the continuing discoveries about gender differences in cardiovascular disease.

How is the cardiovascular system different in women vs. men?

Researchers have found many sex-specific differences in the cardiovascular system. These complex differences, often at a microscopic level, can affect how women experience heart disease compared to men. A few examples include:

Anatomy. Women have smaller blood vessels and heart chambers. The walls of their ventricles (pumping chambers) are also thinner.
Blood count. Women have fewer red blood cells. As a result, they can’t take in or carry as much oxygen at any given time.
Cardiovascular adaptations. Changes in altitude or body position (like quickly standing up after lying down) are more likely to affect women. These changes can lead to sudden drops in blood pressure.
Hormones. Estrogen and progesterone levels are typically higher in women, while testosterone is higher in men. These hormones can impact many aspects of

How common are female heart issues?

According to Dr. Noel Bairey Merz, Director of the Barbra Streisand Women’s Heart Center in Los Angeles, “Cardiovascular disease is the #1 cause of death for women in the United States, and two out of three American women have at least one risk factor.”

What’s equally concerning is that 12 times as many women die of heart disease each year than from breast cancer. This statistic is a wake-up call, highlighting the urgent need for greater awareness and understanding of heart health among women despite its widespread nature.

Researchers only discovered that men and women can experience different symptoms and forms of heart disease about a decade ago. And this crucial insight is still not consistently taught in medical schools.

What are the signs of a woman having heart problems?

While chest pain (also known as angina) during a heart attack is common to both genders, women often experience a range of other symptoms that may not be immediately linked to heart disease.

Here’s a list of the most common signs of heart attack in women:

Discomfort in the neck, jaw, shoulder, upper back, or upper abdomen
Shortness of breath
Pain in one or both arms
Nausea or vomiting
Sweating
Lightheadedness or dizziness
Unusual fatigue
Heartburn or indigestion

These symptoms can often be subtle and less pronounced than the typical crushing chest pain most men suffer during a heart attack. This may be because women experience blockages not only in the main arteries but also in the smaller ones that supply blood to the heart–a condition known as small vessel heart disease or coronary microvascular disease.

Women’s symptoms often occur while resting or even during sleep, too, and may be triggered by emotional stress. It’s also more common for women to have a heart attack without severe blockage in an artery (nonobstructive coronary artery disease).

Because of these differences, women might not be diagnosed as frequently with heart disease as men.

Addressing gender differences in cardiovascular disease

Traditionally, men with blocked arteries are diagnosed using an angiogram (an X-ray of the blood or lymph vessels), a widely accepted and effective method. However, this approach doesn’t always work for women because their arteries are smaller and may not be as visible in the X-ray.

This discrepancy often leads to women being mistakenly given a clean bill of health and sent home without a proper diagnosis. For this reason, Dr. Merz and her team have dedicated the past two decades to identifying patterns of female-specific heart issues, developing innovative diagnostic tools, and creating specialized care tailored to women’s needs.

“This is especially crucial because until recently, medical research has been performed dominantly on men–not including the woman it greatly impacts,” she says.

Thankfully, this trend is shifting, and researchers at the Barbra Streisand Women’s Heart Center have been working to address gender inequalities in diagnosis and treatment and educate women on recognizing symptoms of female heart issues.

Their research has yielded significant findings, especially identifying ischemia with no obstructive coronary artery disease (INOCA).

Female-specific heart disease: INOCA

Researchers recently identified INOCA, a significant but often undiagnosed condition that affects about one-third of women with ischemic heart disease (lack of blood supply to the body, which can be caused by narrowed arteries). This discovery marks a key step in understanding and addressing women’s unique heart issues.

INOCA is caused by dysfunction in the small microvascular blood vessels of the heart, which may go undetected with standard testing. It’s characterized by symptoms that can also indicate other heart conditions. These often subtle symptoms include:

Chest pain or a sense of pressure in the chest area
Subtle shortness of breath, especially during exercise
Heartburn-like sensations, particularly during physical activities

While not typically life-threatening, INOCA can significantly impact your quality of life and raise your risk of serious health issues. Those with INOCA have a 1.3 to 1.8 times greater likelihood of experiencing major adverse cardiovascular events, such as:

Heart attack
Heart failure
Stroke
Cardiovascular death
Death from any cause

If you notice any of the above symptoms, see your healthcare provider immediately for a proper assessment– especially if you’ve ever been diagnosed with gestational diabetes.

Gestational diabetes and heart disease

If you’ve had gestational diabetes (diabetes during pregnancy), you may face a higher risk of cardiovascular disease as you age.

Women with a history of gestational diabetes may be up to 70% more likely to develop heart disease than those who’ve not had the condition. This includes an increased susceptibility to INOCA.

Gestational diabetes manifests as high blood sugar during pregnancy, and typically resolves on its own after childbirth. However, it can have lingering effects on your long-term health.

Studies show approximately 50% of women who’ve been diagnosed with gestational diabetes develop type 2 diabetes within a decade after pregnancy–which, itself, heightens your risk of heart disease.

Women who’ve had gestational diabetes also often have higher levels of calcium buildup in the coronary artery–even if they maintain normal blood sugar levels after childbirth.

This suggests you may have an elevated risk for heart problems later on, regardless of the presence of type 2 diabetes or other risk factors like obesity.

So, what steps can you take to manage these risks? Regular health screenings are critical. Experts recommend women who’ve had gestational diabetes get blood sugar levels and other heart health markers tested every three years.

Adopting healthy lifestyle habits– such as following a balanced diet and
exercising regularly–can also work wonders for your cardiovascular health.

Stay on top of your heart health.

Cardiovascular disease affects women differently than men. With anatomically smaller hearts and different sets of symptoms, understanding these differences is crucial for prevention and effective treatment.

Here are some specific things you can do:

Visit your provider for yearly physical exams.
Work with your provider to manage your blood pressure, cholesterol and
blood sugar. This may involve taking medications.
Make an exercise plan that works for you. Slowly work up to 150 minutes
per week of moderate-intensity exercise (like walking).
Avoid tobacco products and limit alcohol.
Follow a heart-healthy eating plan.

When it comes to heart-healthy eating, remember these simple steps:

Plan. Write down your dietary goals and get advice from a healthcare provider or dietitian. Write down all the foods you want to eat more often and those you want to reduce or eliminate.
Pick. Choose recipes you like and map out your meals for the week. Make
a list to take to the store and stick to that list. If you prefer takeout, make
your own personal menu of heart healthy options and only choose from
those.
Portion. Even healthier foods can become unhealthy in large quantities.
Keep an eye on your portions.
Enjoy! Eating a heart-healthy diet can and should be enjoyable. If the
recipes you’re using aren’t tasty to you, find new ones. Ask friends for
recommendations. And remember that finding a healthy balance is more
effective than strict rules or restrictions in the long run. Talk to your provider about ways to enjoy any favorite foods that may not be on the “heart-healthy” list in moderation.

If you have risk factors for heart disease or a history of heart problems, you’re not alone. More than 18 million adults in the U.S. live with coronary artery disease. And every 40 seconds, someone has a heart attack. These numbers can be startling, but this knowledge also gives you the power to make changes. Research shows that 4 out of 5 heart disease cases can be prevented. So, have a candid,
informed conversation with your doctor, and encourage him or her to perform comprehensive heart health assessments. You’ll not only gain reassurance but take a step towards a longer, healthier life.