February marks American Heart Month, highlighting the importance of cardiovascular health. While Valentine's Day often associates figurative hearts with this month, it's paramount to also address the literal hearts that keep us alive. Heart disease, a leading cause of mortality, affects both men and women, but with distinct differences between the sexes. In fact, this month includes National Wear Red Day, a campaign specifically dedicated to raising awareness about women's heart health. Held on the first Friday in February each year, it serves as a reminder of the unique challenges women face in combating heart disease.

Long thought to be a man's disease

Though heart disease is the number #1 killer in both sexes, knowledge about heart disease historically stemmed from studying how the disease manifests in male hearts, and it has long been thought to be a man’s disease. These misconceptions have led the risk of heart disease to be underestimated in women, which in turn has led to less aggressive treatment strategies and underrepresentation of women in clinical trials throughout history.  It wasn’t until relatively recently that knowledge about how heart disease manifests differently in women became more well known and more tailored care for women developed. 

 

1. Unique Risk Factors for Women

When it comes to heart disease, women face a distinct set of risk factors that may contribute to their susceptibility to this condition. Understanding these unique risk factors is essential for early detection, prevention, and effective management of heart disease in women.

Heart disease risk varies with hormonal health

One consideration for women is hormonal fluctuations. Throughout a woman's life, hormonal changes during puberty, menstruation, pregnancy, and menopause can impact cardiovascular health. Estrogen, believed to offer protective effects against heart disease, may help control cholesterol levels and reduce the risk of fat buildup in arteries. However, hormonal fluctuations, particularly during menopause when estrogen levels decline, can increase the risk of developing heart disease. 

Additionally, pregnancy-related complications such as gestational diabetes can have long-term implications for a woman's cardiovascular health. Women who experience this during pregnancy may be at a higher risk of developing heart disease later in life. Women with endometriosis are also more likely to develop heart disease compared to women without endometriosis in the same age group, Therefore, proper monitoring and management of these unique risk factors a woman may have are crucial for mitigating future cardiovascular risk.

Heart disease does not affect all women equally

It’s also important to understand that heart disease does not affect all women equally. Social determinants of health, such as access to healthcare, education, and socioeconomic status, play a significant role in shaping women's cardiovascular risk. Women from disadvantaged backgrounds may face barriers to accessing quality healthcare, leading to delays in diagnosis and treatment of heart disease. Black women, in particular, face even more inequities when it comes to heart care, being nearly 60% more likely to have high blood pressure than white women. Addressing these social determinants of health is essential for promoting heart health equity among all women.

 

2. Different Heart Attack Symptoms in Women

When it comes to heart disease, the symptoms experienced by women may differ from those commonly associated with men. Recognizing these less commonly associated symptoms is crucial for timely diagnosis and treatment of heart disease in women.

Symptoms besides chest pain

While chest pain is often considered the hallmark symptom of a heart attack, women may present with a broader range of symptoms that are less commonly associated with heart attacks. For example, instead of experiencing severe chest pain, women may report symptoms such as shortness of breath, nausea, vomiting, or discomfort in the neck, jaw, shoulder, or upper back. These symptoms can often be mistaken for other conditions, leading to delays in seeking medical attention and diagnosis.

Furthermore, women may experience what is known as silent heart attacks, where they have a heart attack without experiencing any noticeable symptoms. These silent heart attacks are more common in women than in men and can go undetected, leading to delayed treatment and increased risk of complications.

Recognizing and understanding these symptom differences between sexes is essential for healthcare providers to accurately diagnose heart disease in women. It's also important for women to be aware of these symptoms and to trust their instincts if they suspect something is wrong with their heart health.

 

3. Diagnostic Challenges for Women's Heart Health

Women are more likely to be diagnosed with mental illness when reporting heart attack symptoms

As previously mentioned, women may not exhibit the classic symptoms of heart disease, leading to under-recognition and underdiagnosis of the condition. Women themselves may not recognize the signs of a heart attack or may delay seeking medical attention due to misconceptions about who is at risk for heart disease. Furthermore, women may be less likely to be taken seriously or receive appropriate medical care for their symptoms. In fact, a study in 2009 found that middle-aged women were twice as likely to be diagnosed with mental illness compared to men in the same age group reporting the same symptoms. 

Size matters

From a physiological standpoint, women’s hearts are smaller and tend to have plaque buildup in the smallest vessels called the microvasculature compared to men who have plaque buildup more commonly in large arteries. Cardiac catheterization has long been considered the gold standard for diagnosing heart attacks but that test looks for blockages in large arteries, missing plaque in small arteries and vessels. Another test known as the ​​cardiac troponin (cTn) test looks for the protein troponin, which is released when a heart attack has damaged heart muscles. However, clinical thresholds that signal a heart attack may vary between the sexes with women falling under the traditional level for detection even if they are having a heart attack. As this information becomes more well known, providers are starting to apply sex-specific thresholds in these tests to make them more applicable to women. 

Part of the reason why these diagnostic approaches are less effective for women is because, historically, there has been underrepresentation of women in clinical trials and research studies related to heart disease research. This has resulted in a more limited understanding of how heart disease manifests and progresses in women.

 

4. Tailored Heart Care for Women

Alternative diagnostic approaches

Healthcare providers have decades of experience detecting and treating plaque buildup in large arteries and vessels but there is less understanding on how to do so for plaque in the microvasculature where it is more likely found in women. Rather than using more traditional diagnostic approaches, diagnostic care more suited for women may include cardiac MRI to look for inflammation of the heart, intracoronary imaging to look inside blood vessel walls within the heart, or intravascular ultrasound that may better detect heart disease in women. Ultimately, ongoing clinical research that better recruits female participants will shed additional light and foster better diagnostic tools.

Disparities in medication education

Women are also less likely to take statins, a medication that lowers cholesterol in the blood and has been shown to be highly effective at reducing the risk of heart attacks, even if they are at high-risk. Like much of what has been mentioned before, there is a lack of awareness among women about their risk for heart disease and the benefits of statin therapy, having largely associated heart disease more with men than themselves. Women are also more likely to discontinue statin therapy due to side effects such as muscle pain and weakness. However, choosing statins with fewer side effects can mitigate these concerns, highlighting the need for improved patient-provider education on statin options.

Just like how personalized care benefits everyone, it also benefits women. Making decisions in other health areas while taking into account a woman’s unique heart disease risk factors will minimize the risk of developing heart disease later in life. This is especially important since hormonal changes throughout a woman's life can influence cardiovascular health. Maintaining a primary care physician and getting regular checkups can help women navigate their risks for heart disease as their lives change.

While the attention on women’s health has increased over recent years, the focus has largely been on gynecological, reproductive, and hormonal health. While those health areas are extremely important as well, women can benefit from being more aware of their unique differences when it comes to heart health and to consider how their decisions in other health areas impact their heart health in the long term.

 

5. Self-care is heart health care too, especially for women

The concept and popularity of “self-care” has exploded over the years, especially amplified on social media. While self-care has largely been associated with improving mental health, it has very tangible benefits for heart health too. Women are consistently ranked higher in stress levels compared to men, likely to due to juggling several roles at home and at work. Women are also more sensitive to stress being a trigger for heart disease. Chronic stress can contribute to unhealthy coping mechanisms such as overeating, smoking, or physical inactivity, all of which increase the risk of heart disease. The American Heart Association has concluded that women are at a significantly higher risk for heart disease when exposed to the same stressors as men, highlighting the importance for self-care not only for general wellbeing but also for heart health in women.

Strategies for Managing Stress

• Work out to music: Women as well as men report exercising and listening to music as a main method to destress. Whether you listen to confident boosting girl anthems or peaceful instrumental music, consider grabbing your earphones the next time you head out even just for a brief walk to do an errand.

• Mindfulness: Activities like yoga and meditation have shown to have heart benefits such as blood pressure, heart rate, anxiety and stress. In today’s fast-paced digital age, also consider committing to a wind-down routine before bed, including refraining from phone usage and incorporating relaxing, indulgent activities such as making a mocktail infused with a magnesium powder to aid sleep. See our article on how to have a better relationship with your phone for more digital detox tips.

• Nutrition: Prioritizing whole foods, lean proteins, healthy fats, fruits and vegetables will not only reduce your risk for heart disease but also help put you in a better mood and energy level ready to tackle life. If faced with dietary restrictions or just wanting an extra boost of insurance, consider supplementing with multivitamins and omega-3 fish oil to get a breadth of nutrients and healthy fats.

• Be social: Women are more likely to report that social activities such as spending time with friends and family are relaxing. Whether it’s visiting loved ones or catching up with girlfriends over brunch, consider dedicating time to have an outlet with others to share your feelings and what’s going on in your life.

 

Conclusion

Awareness of the disparities in heart disease between the sexes is imperative for improving outcomes and promoting equity in cardiovascular health. Women face unique challenges in the diagnosis, treatment, and management of heart disease, necessitating tailored approaches that consider their specific physiological, social, and emotional needs.

From the challenges of diagnosing heart disease in women due to differing symptoms and physiological differences to the limitations of traditional diagnostic tests, it is evident that a one-size-fits-all approach is inadequate. Healthcare providers must recognize and address these sex-specific considerations to ensure accurate diagnosis and appropriate treatment for women with heart disease.

Empowering women to advocate for their own heart health and well-being is also crucial. By understanding their unique risks for heart health, women can be more proactive in their day to day self-care as well as in conversations with their providers. Women should feel empowered to seek timely medical attention, ask questions, and seek care that addresses their specific needs.

Ultimately, by addressing the sex disparities in heart disease diagnosis and treatment, we can improve outcomes for women, reduce healthcare disparities, and promote cardiovascular health for all. This American Heart Month, let's raise public awareness and enhance women's self-awareness about heart disease in order to help better prevent cardiovascular events in the future. 

 

 

 

Note: The information in this article is not official medical or healthcare advice and should not be treated as such. Always consult your healthcare professional for specific medical questions and healthcare advice.