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 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 INOCA isn’t typically fatal, it can be debilitating. If you notice any of the above symptoms, see your healthcare provider immediately for a proper assessment.

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.

So, have a candid and 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.

References:

Women and Heart Disease: What We Know Today

Matters of the Heart: Cardiovascular Disease in U.S. Women – PMC

Gender differences in coronary heart disease – PMC

Gender Bias in Cardiovascular Disease Prevention, Detection, and Management, with Specific Reference to Coronary Artery Disease – PMC

Cardiovascular Disease in Women: Understanding Symptoms and Risk Factors – PMC

Cardiovascular Disease and the Female Disadvantage – PMC

Cardiovascular Disease in Women | Circulation Research

Coronary microvascular disease: current concepts of pathophysiology, diagnosis and management – PMC

Angina (Chest Pain) – Symptoms | NHLBI, NIH.

Coronary Heart Disease – Women and Heart Disease | NHLBI, NIH

Emotional stress and heart disease in women: an interview with Dr. Viola Vaccarino | NHLBI, NIH