HEART DISEASE HEART ATTACK HEART

ATTACK CAUSES

11 Facts About Heart Medical Reviewer

Attacks in Women David M. Axelrod, M.D.

by Matt McMillen Health Writer

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TIME FOR A heart to heart: When it comes to

heart attacks, men and women are not
created equally. While their hearts may
look the same, there are actual
physiological differences that often affect
symptoms when a heart attack strikes.
These differences sometimes make heart
 attacks harder to diagnose in women. Even
so, male or female, if you have a heart
attack it’s always a health emergency that
requires immediate medical treatment. The
key is knowing what to look for, so let’s get
to it.
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Women Have Some Unique

Risk Factors
Being a woman means you can develop
conditions that men can’t. We’re talking
things like endometriosis, polycystic ovary
disease, and pregnancy-related high blood
pressure (HBP), all of which can bump up
the odds of having a heart attack. In fact, a
study at Brigham and Women’s Hospital
found that women with endometriosis, a
painful disorder where uterine tissue grows
in other areas of the pelvis—were up to
three times more likely to have a heart
attack, experience chest pain, or need
treatment for blocked arteries. The possible
culprit? The chronic inflammation that
accompanies endometriosis may also
inflame the arteries.
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Common Risk Factors Are

More Dangerous for Women
Both men and women can get diabetes,
have HBP, or struggle with depression. Yet if
you’re a woman with any of these
conditions, you may be at greater risk for a
heart attack than a man who has the same,
according to the American Heart
Association. In fact, clinical depression—
twice as common in women as it is in men
—doubles a woman’s heart attack risk. It’s
thought that women’s range of symptoms
may go untreated, either because they put
their families first and don’t see a doctor, or
their symptoms are wrongly diagnosed or
even dismissed when they do.
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Estrogen May Be Protective—

to a Point
Women tend to have heart attacks later in
life than men do: The average age for a first
heart attack is 72 in females and 65 in
men. Experts believe women’s exposure to
estrogen through most of their reproductive
life provides some extra protection against
heart attacks, but only until about age 50
or so. You know what happens around then
… menopause. Once those hormone levels
drop, the advantage goes away, says
Michael Goyfman, M.D., the director of
clinical cardiology at Long Island Jewish
Forest Hills in Queens, NY.
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Younger Women Are Having

More Heart Attacks
We know, we just said women’s higher
estrogen levels may be a benefit—and in
general that’s true. But according to a 2019
study published in Circulation, heart attacks
are rising among younger women, and
they’re especially dangerous and deadly.
It’s still unclear what’s driving the increase,
but researchers speculate that young
women overall are less healthy today than
they were 20 years ago. Young women,
defined in the study as ages 35 to 54, were
more likely than men to have diabetes, high
blood pressure, kidney disease, and stroke
—which all have connections to heart
disease.
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For Men, Heart Attack

Symptoms Usually Come on
Fast…
Plaque buildup in the arteries can lead to
heart attacks in both men and women—but
how that plaque triggers one can be very
different. Among men, plaque often
suddenly ruptures, or breaks apart. The
body’s emergency response system forms a
protective blood clot. Unfortunately, that
clot can block an artery that supplies blood
and oxygen to your ticker, causing a heart
attack. Such ruptures account for 75% of all
heart attacks in men but only 55% in
women.
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…and the Symptoms Are

Obvious
When plaque ruptures and completely
blocks an artery—again, more common in
men—the symptoms are severe. Men will
likely experience crushing chest pain and
heaviness. “Imagine an elephant sitting on
your chest,” says Dennis Bruemmer, M.D.,
a cardiologist at the Cleveland Clinic in
Ohio. Additional, less-obvious symptoms
for men include: shortness of breath; pain in
other parts of the upper body like the arms,
neck, and jaw; and nausea.
Women can sometimes experience some
or all of these symptoms, too, adds Dr.
Bruemmer. However, they often show
subtler or milder signs of heart attack. More
on that next.
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For Women, Heart Attacks

Can Occur in Slo-Mo…
Women—especially those under 60—often
experience what’s called plaque erosion.
As erosion occurs, bits of plaque wear
away, and smaller blood clots form in
response. Unlike a sudden rupture, which
causes immediate, unmistakable symptoms
—like severe chest pain—this erosion takes
place over time. Symptoms may come on
gradually, too. This is particularly true in
women who have not yet been through
menopause, although it’s not yet known
why. “We don’t understand this well,” Dr.
Bruemmer admits.
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…and Symptoms Can Last

for Weeks
Because women, especially those under
55, are less likely to have complete
blockages, their symptoms may appear
gradually and seem less severe than men’s.
“They present with what we call atypical
symptoms—vague symptoms like fatigue,
nausea and vomiting,” says Dr. Bruemmer.
Other symptoms in women may include:
dizziness; sweating; pain in places like the
jaw, either arm, shoulder, back, or stomach
He adds that it’s important to note how
vague and mild symptoms in women can
begin three to four weeks before a heart
attack strikes.
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Women Are Less Likely to

Survive a Heart Attack
More women than men die in the aftermath
of a heart attack, according to a study
published in Circulation. This may be
because women tend to wait longer before
going to the hospital, perhaps because
their symptoms are vague or don’t seem
life-threatening, says Dr. Goyfman. Once at
the ER, they’re less likely to get the right
kind of treatment because their heart
attacks can be harder to diagnose, he
adds. Women’s heart attacks are also more
likely to be caused by blockages to small
arteries, which angiograms often can’t pick
up.
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Treatment After a Heart

Attack Is Often Less
Aggressive for Women
After surviving a heart attack, women are
at greater risk for blood clots that can
cause another heart attack, according to
the Cleveland Clinic. Yet, for unknown
reasons they’re less likely to receive
medication to prevent blood clots, which
may explain why women are more likely to
have a second heart attack within 12
months. Women are also less likely to be
referred to a cardiac rehabilitation facility
for heart health education and exercise,
nutrition, and stress relief guidance. Over
the past 30 years, fewer than one in five
women who’ve had heart attacks received
cardiac rehab care.
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Both Men and Women Can

Prevent Heart Attacks
Whether you’re a man or a woman, there
are steps you can take to reduce risk and
help prevent a heart attack. Do everything
in your power to quit smoking. Get at least
 150 minutes of exercise each week. Eat a
nutritious, heart-healthy diet, like the
Mediterranean or DASH diets. See your
doctor on the regular to track HBP, high
cholesterol, and high blood sugar levels.
Maintain a healthy weight. “While men
and women can present with different
symptoms of heart attacks, they should take
the same steps to prevent heart attacks in
the first place,” says Dr. Goyfman.
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