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Published on February 25, 2019

A life-threatening gender gapA life-threatening gender gap

When it comes to heart health, a gender gap exists that puts women at significantly greater risk for heart attacks, if they have certain risk factors. Even though overall men are at greater risk of heart attack than women, females face significantly more risk than men if they have high blood pressure, smoke, or have diabetes, an observational study done in the United Kingdom shows.

For the study, 471,998 people with no history of cardiovascular disease were followed over seven years. The study subjects were between the ages of 40 and 69 years and 56 percent of them were women. During that time period, 5,081 people (29 percent of whom were women) had their first heart attack.

High blood pressure raised a woman’s risk by an extra 83 percent relative to its effect on men. Smoking increased a woman’s risk of heart attack by 55 percent more than it did for men. Type 2 diabetes had a 47 percent greater impact on women and type 1 diabetes had close to three times greater impact on women.

Cape Cod Hospital cardiology hospitalist Jennifer Ladner, MD, said she is well-aware of the higher risk and added that higher cholesterol is also a higher risk factor for women than men.

“It’s kind of a curiosity,” she said. “It is something that is noted but we don’t know why. It’s important to note that all the risk factors for men and women are the same, it’s just that some have a greater impact on women than men.”

What is known is that women’s treatment is often delayed for a variety of reasons. They are not watched as vigilantly as men because women are somewhat protected from cardiovascular diseases through menopause. After menopause women catch up to men pretty quickly, even if they are on hormone replacement therapy, said Dr. Ladner.

Another problem is that women tend to downplay symptoms or might not even recognize the symptoms because they don’t always have the classic heart attack symptoms.

“Women’s symptoms of cardiovascular disease tend to be more vague and not the classic chest pain shortness of breath that men have,” Dr. Ladner said. “The original studies looking at heart disease and heart attacks were looking at men, so the classic symptoms are the classic symptoms for men. Women’s symptoms can be much more vague, such as just getting fatigued or just not having energy and so, often, their heart disease is not recognized or diagnosed until later on in the course of their disease and it is in a much more advanced stage.”

Men’s symptoms of heart attack include:

  • Chest pain
  • Pain radiating down the arm
  • Shortness of breath
  • Nausea
  • Sweating

“In women it could be those symptoms, but it’s less commonly those,” Dr. Ladner said. “I wouldn’t say there is a list of classic symptoms for women. It’s just that they tend to be much more subtle.”

Importance of Exercise

One of the big warning signs for women is fatigue or shortness of breath when walking or exercising. If you typically walk a certain distance every day without any problems, but then discover that you are tired at half that distance, that is a red flag that you might have cardiovascular disease that you need to give attention.

“A lot of people as they start to get older attribute their symptoms to getting older,” Dr. Ladner said. “If you exercise regularly, your exercise tolerance shouldn’t change in a six-month period of time. Maybe it will over 10 years, but not over six months, if you are exercising regularly.”

Which makes exercise for the prevention of heart attack a double benefit. Not only will it delay or lessen the chance of heart disease, it will also be a good indication if you are in trouble.

“Exercise is right up there with not smoking in terms of lowering your cardiovascular risk,” she said. “Plus if someone exercises regularly, they’re going to be much more in tune to how their body feels when they are exercising. That means they are also going to notice a change earlier on. By the time someone starts having symptoms when they are just at rest, their disease is very advanced.”

Exercise will also help prevent the other risk factors like diabetes, high blood pressure and high cholesterol, which further lowers risk. All too frequently, exercise gets dropped by the wayside in our busy culture, she said. Plus people overestimate how much exercise they get in their day-to-day-life. Using a device like a Fitbit or the fitness tracker on your iPhone can help you figure out exactly how many steps you are walking in a day and remind you to step it up when you fall short of your daily goal.

If you feel more fatigued just walking 20 feet, call 911 and get to the Emergency Department right away. But if it’s a more gradual sense of fatigue, Dr. Ladner recommends going to your primary care physician and describing your symptoms. Your PCP will do a physical exam, check your blood pressure and pulse and do an EKG. If there is cause for worry, the next step would be a stress test.

Early detection of cardiovasular disease in women is important because women tend to be diagnosed later in their disease which causes more complications as a result.

“Women need to not downplay symptoms if something is different in terms of how they feel and their exercise tolerance,” Dr. Ladner said. “They need to get it checked out.”