Updated: Sep 29, 2022
To help avoid literal heartbreak this February we wanted to highlight some shocking truths and dispel some of the harmful myths that surround heart disease in women.
Coronary Heart Disease (CHD) is the single biggest killer of women, killing over twice as many women as breast cancer worldwide. Four women per hour are admitted to hospital following a heart attack in the UK. Worse still, heart attacks in women have worse outcomes, including higher death rates, than in men. Why is it then we continue to carry the misconception that this is a man’s disease?
Let’s take a look into some factors that contribute to the heart health gender gap.
Causes of Chronic Heart Disease and how it presents can differ between men and women. This can lead to an incorrect diagnosis being made. Dismissal of symptoms by both clinicians and women themselves, believing them to be caused by alternative diagnoses, such as anxiety, can be fatal. However, it is important to know that heart attack symptoms do not always vary from men to women, they just present differently for different people.
Women are often underrepresented in clinical trials. Our knowledge of how safe and effective certain therapies are in women compared to men, therefore, is limited. In turn, this means many interventions, both preventative and after a heart attack, are underutilised in women.
There is a lack of awareness among women and doctors of women’s heart disease symptoms and presentation. This includes recognising the seriousness of chest pain. One horrifying statistic is that approximately 41% of women wait more than 12 hours before seeking help when experiencing chest pain.
It is clear that women need to be empowered to recognise their risk factors and their symptoms. Even more importantly women need to report any worrying symptoms without delay. When you report your symptoms, you can get help whether it is emergency treatment and care, or even just some initial monitoring to ensure everything is OK. However, do not dismiss symptoms and assume they will go away. Even if it isn’t CHD, it could be something else that is dangerous to your health.
Reminder of Symptoms
According to the British Heart Foundation, “it’s a common misconception that men and women experience different heart attack symptoms. While symptoms vary from person to person, there are no symptoms that women experience more or less often than men.” Believing that women will present with “atypical” symptoms compared to men is causing women confusion when it comes to recognising and acting on the warning signs.
In both men and women, chest pain that doesn’t go away is still the most common symptom of a heart attack. This pain often feels like a tightness, pressure or squeezing. There might also be a pain in either arm that can spread to your neck, jaw, back or stomach. Both men and women also share the symptoms of lightheadedness, sweating and breathlessness. However, there are some additional symptoms women need to look out for. For example, a woman having a heart attack may also feel pain between the shoulder blades and experience nausea and/or vomiting. Less common symptoms also include experiencing a sudden feeling of anxiety that can feel similar to a panic attack. In some cases, you may also have excessive coughing or wheezing.
There are a number of factors that can lead to heart disease amongst women. It is important to understand these and how they could put you at risk. Early monitoring and preventative care can do a lot to help decrease the severity of the risk. Here are some of the main risk factors:
High blood pressure
Hormone changes after the menopause
Pregnancy complications including high blood pressure, gestational hypertension, preeclampsia, gestational diabetes, preterm delivery(baby born before 37 weeks), placental abruption, still birth.
Read more about the connections between pregnancy and heart disease on our blog here. If you have had any of these pregnancy complications please be sure to discuss them with the doctor and have a conversation about preventative care.
Menopause and Heart Disease
So how does menopause affect your heart? Well in simplified terms, it relates to oestrogen, a hormone naturally produced by a woman’s body during her menstrual cycle. Oestrogen is protective against heart disease because it helps to control your cholesterol levels. By doing so, it reduces the risk of fatty plaques building up inside the artery wall causing it to block. During perimenopause and after menopause, a woman’s body gradually produces less and less oestrogen which in turn increases your risk of heart disease. If you have early menopause (under 40 years) you are at higher risk of early coronary heart disease, so treatment with either HRT or the combined contraceptive pill is very important.
So are women at risk for heart disease before menopause? Yes, they certainly are. One-third of cardiovascular problems in women occur before the age of 65 years. What is really upsetting about this is that these women often have family/work commitments and often put others before themselves, seeking help too late.
Take a look at this link designed to help you assess your risk of heart disease
A healthy diet, regular exercise, not smoking, moderating alcohol and maintaining healthy blood pressure, blood sugar level, cholesterol level and body weight can help to prevent most cases of heart disease.
It’s believed that in the UK, almost 7million women have high blood pressure (up to 2.5 million may be undiagnosed). In addition, nearly 2 million women are living with diabetes, and nearly half of all women in the UK have elevated cholesterol levels above national guidelines. A UK study suggests that smoking, diabetes and high blood pressure increase the chance of a heart attack more in women than in men. These factors add up to an “excess risk” which women are generally not aware of.
I urge all eligible women to access The NHS Health Check via their GP surgery. This is a health check-up for adults in England aged 40 to 74. By doing this it can help identify and find ways to lower your risk. Please be aware that at present these are paused in some areas due to the Coronavirus pandemic. You can find out by contacting your local council.
Many women ask me if there is a place for dietary supplements in the prevention of CHD? For most of us, these are not necessary unless they have been prescribed by a health care professional, and in some cases can even be harmful. None of the most recent UK official guidance for the prevention and management of CHD recommends the use of dietary supplements.
For further information on how being a woman can put you at a disadvantage when it comes to heart disease I would strongly recommend having a look at the following briefing released by the British Heart Foundation in 2019.
1. UK hospital statistics, 2017-18; NHS Digital/ ISD Scotland/NHS Wales/DH Northern Ireland
2.Heart disease deaths rising in young women. ESC press release, 10 Feb 2021
3. Ferry AV, Anand A, Strachan FE, Mooney L, Stewart SD, Marshall L, Chapman AR, Lee KK, Jones S, Orme K, Shah ASV, Mills NL. Presenting symptoms in men and women diagnosed with myocardial infarction using sex-specific criteria. J Am Heart Assoc. 2019;8(17):e012307. doi: 10.1161/ JAHA.119.012307. Epub 2019 Aug 20.
4. van Oosterhout REM, de Boer AR, Maas AHEM, et al. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis. J Am Heart Assoc. 2020;9:e014733. DOI:10.1161/JAHA.119.014733. http://ahajournals.org/doi/10.1161/JAHA.119.014733
5. Sniderman AD, Thanassoulis G, Williams K, et al. Risk of Premature Cardiovascular Disease vs the Number of Premature Cardiovascular Events. JAMA Cardiol. 2016;1:492–494.
6. BHF estimates based on latest UK health survey data (NHS Digital & Scottish Government)
7. Millett ERC, Peters SAE, Woodward M, Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants, BMJ, 2018:363:k4247. doi: 10.1136/bmj.k4247