LiveSmart: Women and Heart Disease – A Gender Gap in Awareness, Prevention

[Written by John Filippone, MD, Albany Associates in Cardiology, a member of St. Peter’s Health Partners Medical Associates.]

Cardiovascular disease is the leading cause of death in the U.S. for both men and women. But, there are important gender disparities in terms of the risk factors for developing heart disease, the clinical presentation, and treatment.

The most typical presentation of coronary artery disease (CAD) or heart attack, in both men and women, is central chest discomfort, often described as tightness or heaviness that may radiate into the neck, jaw or arm. These symptoms are often accompanied by shortness of breath or nausea.

Women, however, are more likely than men to present without chest pain. Women may have shortness of breath alone, back pain, generalized fatigue or dizziness. They are also more likely to develop symptoms at rest or in response to emotional or mental stress, whereas men’s symptoms are more commonly provoked by physical exertion.

It is important to note that while women are more likely than men to have atypical symptoms, they share more similarities than differences, and most women will present with the typical symptoms.

For men and women alike, the risk factors for heart attack include age, hypertension, high cholesterol, diabetes, tobacco use, obesity, and family history. There are some important differences, though.

Women with Type 2 diabetes are more likely than men with diabetes to develop CAD. Similarly, smoking seems to carry a greater risk for women than it does for men. The most important difference is the unique role of hormonal influence in women. During menopause, estrogen levels decrease significantly and this can lead to adverse effects on the lipid profile and accelerated development of atherosclerotic plaque in the blood vessels.

While recommendations for prevention of CAD (addressing high blood pressure and cholesterol; avoiding tobacco and alcohol; 150 minutes of aerobic exercise weekly; and a healthy diet low in sugar, saturated fats and sodium) and for treating established disease (medications such as aspirin and statins; procedures including stents and bypass surgery) are similar for both groups, there are important disparities in terms of how therapy is delivered. For example, women with CAD or a heart attack are less likely than men to be treated with aspirin or a statin medication for lowering cholesterol. Women are also less likely than men to undergo surgical bypass surgery or to be referred to cardiac rehabilitation following a heart attack.

There may be many explanations for why therapies are applied differently between the sexes. It may relate in part to the fact that women can present with less typical symptoms, making it more difficult to diagnose CAD. In addition, the majority of cardiovascular research trials that have established therapies have enrolled predominantly white males. As a result, women have been under-represented in cardiovascular research leading to significant knowledge gaps with regard to heart disease in women, risk factors and treatment response.

The most important message we can give to women with regard to cardiovascular disease is to be proactive with your prevention. Following up regularly with your primary doctor to identify risk factors and to treat them aggressively is the best way to prevent disease.

St. Peter’s Health Partners offers the full spectrum of cardiology services, including diagnostic testing, state-of-the-art imaging studies, and noninvasive therapies. From heart health monitoring to lifesaving therapies, you can count on us for services that are tailored to your needs.

To find a location and read more about our cardiology offerings, visit or call 1-800-HEART-76 (1-800-432-7876).

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