When women visit their doctors, it’s often for ‘women’s issues’ – a breast check, a Pap smear or something related to having children (and then raising children). When it comes to women’s health, we are all guilty of thinking of women’s health and women’s reproductive health as the same thing.
In the US alone, 48 million women have heart disease.
Around the world, ischaemic heart disease which includes heart attacks, accounts for one third of deaths. Heart disease is the leading cause of death for women in a number of countries, including Australia, the UK and the US. In the US alone, 48 million women have heart disease. Yet, in Australia, the Heart Foundation conducted research which showed only a 2 in 10 women felt that heart disease was relevant to them, a figure which rose to only 3 in 10 after many years of campaigning.
In recent years, doctors and patients alike have become much more aware that when it comes to women’s hearts, we’re all letting women down. When compared to their male counterparts, women are more likely to die of their heart disease. They’re also subject to a number of unique problems and risks to their heart health including pregnancy and higher incidences of some other heart diseases.
…women are more likely to die of their heart disease.
So why the difference? Why are women’s hearts different? What should you look out for and what can we all do to help protect women’s hearts?
The biology of a woman’s heart
Strictly speaking, if we were to have a woman’s heart side by side with a man’s, they look the same. Aside from a woman’s heart being a little smaller because women tend to be a little smaller than men, the basic building blocks are the same. However, when we look a little closer, we see some differences in how the two work and how they get sick.
One of the biggest biological events in a woman’s lifetime is menopause. At this time, the levels of oestrogen in her blood decline. This leads to the traditional symptoms of menopause but has a very important side effect on the heart. Oestrogen is good at keeping blood vessels healthy and supple and at keeping cholesterol levels quite safe. When the oestrogen falls, we know that blood vessels become stiffer, more likely to build up plaque and cholesterol becomes higher with high levels of the bad LDL cholesterol.
A woman’s blood vessels and her heart are particularly prone to the ill effects of other illnesses. For reasons we’re not sure of yet, diabetes, hypertension (high blood pressure) and smoking seem to cause more damage to women than men.
Finally, the way in which heart attacks happen in men and women can be different. A heart attack happens when the coronary arteries which supply blood to the heart develop blockages. In men, these blockages tend to be big, bulky plaques that stick out into the middle of the vessel. These blockages are easy to see on tests like a coronary angiogram and tend to respond well to the treatments that we have. Women however, often have a different form of the disease. Up to 60% of women who have symptoms don’t have these big plaques. Rather, they have blood vessels that are more reactive; they squeeze and spasm aggressively, another area that is under intense investigation.
Symptoms of heart disease
Most of us are familiar with the traditional way heart disease is seen on TV or in in movies. Usually, the character falls over clutching their chest. Pain in the middle of the chest that travels down the left arm or into the jaw is traditionally associated with heart disease. However, only 31% of women have chest pain. Women tend to have more symptoms that are a little harder to pick such as shortness of breath, weakness, arm, back or jaw pain (without the chest pain), palpitations, dizziness or tiredness. These symptoms make picking heart disease notoriously difficult for the woman and her doctors or nurses alike. If we all struggle to pick these things up, it means that we lose precious time in treating the heart disease.
…only 31% of women have chest pain.
Women are also more likely than men to have their symptoms attributed to anxiety or being overly worried. Women tend to prioritise their other tasks whether that be work or caring for children and delay having any issues seen to promptly. Getting women to know more about their hearts is important as is making sure doctors and nurses too are aware of heart disease in women.
The way we treat women’s hearts
Over many years, we have managed to refine the way we treat heart problems. These advances in medicine, surgery and cardiology meant that we started to see much better survival in people with heart disease. However women with heart disease haven’t really shared in this gain, owing to late recognition of their heart troubles and less use of the best possible treatments in women. We’re also beginning to see that our ‘best medical treatment’ don’t seem to pack the same punch in women as they do in men.
Women who have heart attacks or heart failure experience a nearly double risk of dying. This seems to happen because of these underlying biological differences but also because after a heart attack, women don’t get what they need. This includes medicines but also other important things like heart surgery or stents. Now some of this may be cultural but in other cases, because women’s heart disease is different, the treatments aren’t given because they’re thought not to work as well. When women do have treatment for heart disease, they have different side effects that aren’t seen by men.
Women who have heart attacks or heart failure experience a nearly double risk of dying.
Cardiac rehabilitation is an important part of heart care where after a diagnosis of a heart condition, people participate in a structured exercise program. These programs reduce symptoms and the need for readmission into hospital. Women don’t go to cardiac rehabilitation though; they’re not referred or they have significant barriers to getting there like financial constraints or still needing to be someone’s primary care giver.
While we’re still working out which treatments may work better for women, that doesn’t mean that we should under-treat women and tackling the other reasons behind lack of treatment. As for treatments that are tailor-made for women’s hearts, they’re being worked on as we speak.
Broken hearts and babies
There are a few conditions that tend to cause heart trouble in women more so than men. Spontaneous coronary artery dissection is a disease where a tear occurs out of the blue in the coronary arteries of the heart. It’s a common cause of a heart attack in young women and it can be easily missed.
Takotsubo cardiomyopathy is another heart disease that we see more commonly in women than men. It happens usually after a severe emotional stress and causes the heart to pump poorly. It’s often referred to as ‘broken heart syndrome’ and may happen because the heart is very sensitive to adrenaline released during a big shock. This disease can be very serious and researchers are unravelling its how’s and why’s.
Finally, pregnancy is shaping up as an interesting time for a woman’s heart. We now know that illnesses during pregnancy like pre-eclampsia, eclampsia and diabetes mean that a woman is at higher risk of heart problems in the future. It’s important for women who have these problems to keep their doctor informed and take extra care of their hearts.
What can you do to take care of your heart?
As you may have gathered, we have a lot of work to do when it comes to raising awareness around women’s hearts. The Heart Foundation (Australia) asks a simple favour of all of us and that is to tell three women to take care of their hearts. Raising awareness amongst us all including health care professionals is so vital in the fight against heart disease.
However, it doesn’t stop there. Since women are slightly more prone to the ill effects of diabetes, inactivity or smoking, prevention reigns supreme for women’s hearts. Studies have shown that no matter their body weight, exercise can half in some people, the risk of heart problems in women. It’s also vital to know your own risk and your doctor can help you work this out by checking your blood pressure and your cholesterol as well as screening for diabetes. Even young women should know their blood pressure, blood glucose and cholesterol and when you have other health checks say for the contraceptive pill, a Pap smear or checks for the kids, that is a great time to make sure you’re checked out too.
Finally, be aware of your own body. If you have something that isn’t quite right such as pain in the chest, back, abdomen or arm, shortness of breath, lacking in energy which makes it hard to do the things you used to do, make sure you get yourself to your doctor to get checked out and take care of your heart.
Please visit our additional articles to learn more about Broken Heart Syndrome (Takotsubo Cardiomyopathy):