A long-held belief has been that women are less prone to heart attacks, because of their so-called oestrogen advantage. Heart attacks in men is much higher than women. By classic teaching women have an advantage of 10 years in terms of getting cardiovascular disease (CVD), usually around the age of 55, compared to men who can get a CVD around the age of 45. That is partially correct as well, but one should be extra careful about the hugely increased vulnerability of post-menopausal women. More recent research findings that even younger #Sushmita Sen shared that she has had to undergo angioplasty, much public surprise centred on her age.
As a Lancet global commission has emphasised, despite being responsible for causing 35% of deaths in women each year, their cardiovascular disease remains understudied, under-recognised, under-diagnosed, and under-treated, with women also under-represented in clinical trials.
Heart disease may be considered by some to be more of a problem for men. Because some heart disease symptoms in women can differ from those in men, women may not know what to look for.
The following discussion is about the differences in cardiovascular disease between men and women.
How is the cardiovascular system different in women vs. men?
Researchers have found many sex-related differences in the cardiovascular system. These complex differences, often at a microscopic level, can affect how women and men experience heart disease. A few examples include:
- Anatomy. Women have smaller blood vessels and heart chambers. The walls of their ventricles are also thinner.
- Blood count. Women have fewer red blood cells. As a result, women 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) affect women more than men. Women are more likely to have sudden drops in blood pressure or faint.
- Hormones. Estrogen and progesterone dominate in women and people AFAB, while testosterone dominates in men and people AMAB. These hormones can impact many aspects of heart health and overall health.
Heart attack symptoms for women
The most common heart attack symptom in women is the same as in men — some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes.
But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe heart attack pain as pressure or tightness. And it’s possible to have a heart attack without chest pain.
Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:
- Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort
- Shortness of breath
- Pain in one or both arms
- Nausea or vomiting
- Lightheadedness or dizziness
- Unusual fatigue
- Heartburn (indigestion)
These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.
Compared with men, women tend to have symptoms more often when resting, or even when asleep Emotional stress can play a role in triggering heart attack symptoms in women.
Because women’s heart attack symptoms can differ from men’s, women might be diagnosed less often with heart disease than are men. Women are more likely than men to have a heart attack with no severe blockage in an artery (nonobstructive coronary artery disease).
Heart disease risk factors for women
Several traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — affect both women and men. But other factors may play a bigger role in the development of heart disease in women.
Heart disease risk factors for women include:
- Diabetes. Women with diabetes are more likely to develop heart disease than are men with diabetes. Also, because diabetes can change the way women feel pain, there’s an increased risk of having a silent heart attack — without symptoms.
- Emotional stress and depression. Stress and depression affect women’s hearts more than men’s. Depression may make it difficult to maintain a healthy lifestyle and follow recommended treatment for other health conditions.
- Smoking. Smoking is a greater risk factor for heart disease in women than it is in men.
- Inactivity. A lack of physical activity is a major risk factor for heart disease.
- Menopause. Low levels of estrogen after menopause increase the risk of developing disease in smaller blood vessels.
- Use of Contraceptives – They do tend to increase a woman’s blood pressure. If a woman has other risk factors for heart disease, taking birth control pills can compound that risk of heart disease.
- Pregnancy complications. High blood pressure or diabetes during pregnancy can increase the mother’s long-term risk of high blood pressure and diabetes. These conditions also make women more likely to get heart disease.
- Family history of early heart disease. This appears to be a greater risk factor in women than in men.
- Inflammatory diseases. Rheumatoid arthritis, lupus and other inflammatory conditions may increase the risk of heart disease in both men and women.
Women of all ages should take heart disease seriously. Women under age 65 — especially those with a family history of heart disease — also need to pay close attention to heart disease risk factors.
Living a healthy lifestyle can help reduce the risk of heart disease. Try these heart-healthy strategies:
- Quit smoking. If you don’t smoke, don’t start. Try to avoid exposure to secondhand smoke, which also can damage blood vessels.
- Eat a healthy diet. Opt for whole grains, fruits and vegetables, low-fat or fat-free dairy products, and lean meats. Avoid saturated or trans fats, added sugars, and high amounts of salt.
- Exercise and maintain a healthy weight. If you’re overweight, losing even a few pounds can lower heart disease risks. Ask your health care provider what weight is best for you.
- Manage stress. Stress can cause the arteries to tighten, which can increase the risk of heart disease, particularly coronary microvascular disease. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to tame stress.
- Avoid or limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
- Follow your treatment plan. Take medications as prescribed, such as blood pressure medications, blood thinners and aspirin.
- Manage other health conditions. High blood pressure, high cholesterol and diabetes increase the risk of heart disease.
Exercise and heart health
Regular activity helps keep the heart healthy. In general, aim for at least 30 minutes of moderate exercise, such as walking at a brisk pace, on most days of the week. If that’s more than you can do, start slowly and build up. Even five minutes a day of exercise has health benefits.
For a bigger health boost, aim for about 60 minutes of moderate to vigorous exercise a day, five days a week. Also do strength training exercises two or more days a week.
It’s OK to break up your workouts into several 10-minute sessions during a day. You’ll still get the same heart-health benefits.
Interval training — which alternates short bursts of intense activity with intervals of lighter activity — is another way to maintain a healthy weight, improve blood pressure and keep the heart healthy. For example, include short bursts of jogging or fast walking into your regular walks.
You can also add exercise to your daily activities with these tips:
- Take the stairs instead of an elevator.
- Walk or ride your bike to work or to do errands.
- March in place while watching television.
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