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Heart Health Facts for Women

It's no surprise that men and women are different, but when it comes to diagnosing and treating heart disease those differences can mean life or death.

Heart disease is the number one killer of women over 65 and the second leading cause of death for women from 45 to 64. Statistically, one in four women dies of heart disease.

There is a one in nine chance of getting breast cancer, yet most women are aware of their risks and get regular mammograms. Surveys show that less than half of all women are aware of the risks of heart disease or how to reduce their risk.

One of the reasons that heart attacks are often more serious, and even fatal, for women is that the symptoms go undiagnosed. Doctors are taught to look for complaints that include

• Pain or discomfort in the center of the chest
• Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach
• Other symptoms, such as shortness of breath (feeling like you can't get enough air), breaking out in a cold sweat, nausea (feeling sick to your stomach), or feeling dizzy, faint or woozy.

The problem is that women do not tend to experience the "chest-crushing" pain traditionally associated with heart attacks that men do. Most women — and many men with atypical symptoms — tend to experience fatigue and nausea instead.

Women often complain of flulike symptoms, unusual tiredness, trouble sleeping, problems breathing, indigestion or an upset stomach, and anxiety — feeling uneasy or worried. It isn't hard to understand that treating a woman for the flu, indigestion or anxiety when it is the signal of heart disease or a heart attack can be dangerous. With common symptoms, treatment for a heart attack is immediate and urgent. If sleepnessness and nausea are the complaints, by the time the heart problem is finally diagnosed and treatment started the woman's heart may have been damaged beyond hope of repair.

The GENESIS project, funded by the Canadian Institutes of Health Research in partnership with the Heart and Stroke Foundation of Canada, is a multidisciplinary project bringing together researchers from across Canada to examine how sex and gender play a role in heart disease.

Their research has resulted in some fascinating findings. It turns out that men and women develop, have symptoms of, are diagnosed with and are treated for heart disease very differently.

• Teenaged boys develop higher blood pressure than teenaged girls - something that may be due to puberty, or could be tied to the higher blood pressure seen in adult men. Women don't catch up until after menopause, when their blood pressure, and their risk of heart disease, tends to increase.

• Angiograms, the tool used to diagnose heart problems when patients show up in hospitals with chest pains, tend to deliver a "normal" verdict for many women who have serious heart disease. This might be because the plaques tend to be more evenly distributed in women's smaller coronary arteries and are difficult to see. Combined with the vauge symptoms, this leads to heart disease in women going untreated.

• While most drugs used to treat heart failure work in both women in men, some work better than others. For instance, while both are antihypertensive medications, ACE (angiotensin converting enzyme) inhibitors tend to work better for men, while ARBs (angiotensin receptor blockers) tend to work better for women.

What it all adds up to, says Dr. Louise Pilote, the lead investigator of GENESIS, is an increasing need to look as deeply at what divides us as at what we have in common when it comes to heart disease.

"It could be that, in the future, you choose a drug based on the sex of the patient," she says. "And maybe an angiogram isn't such a good test for diagnosing coronary disease in women."

As well, Dr. Pilote underscores the importance of women recognizing signs they could be having a heart attack, even if they are not the "typical" signs we read about, and get themselves to a hospital as quickly as possible.

Other studies now taking place as part of the GENESIS project are looking at alternative ways of testing for heart disease, tests that would recognize the disease in women equally as well as men. They are also examining whether genetic markers for hypertension and obesity, both of which can lead to heart disease, are different in women and men.

Related Resources

Women's Health - Heart Disease

The Heart Truth

Heart disease in women: A Mayo Clinic specialist answers questions
All women face the threat of heart disease. But becoming aware, logging steps on a pedometer, eating healthy and other measures can help protect you.

The Heart Disease Prevention Program

The BBC Heart Disease Guide

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This information is intended as reference and not as medical advice.
All treatment decisions should be made by medical professionals.