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Heart Attack Risk in Women

Cardiovascular disease is the leading cause of death among women in the US. In this article, we explore reasons why it may be harder to diagnose a heart attack in women than in men and what can be done to tackle this dangerous health issue

According to a study conducted in 2017 by a group of researchers from the Women’s Heart Alliance, 50% of young and middle-aged women underestimate the risk that cardiovascular disease may pose to their lives and health.

In the study, 1,011 women aged 25 to 60 – a randomized group representing women across the U.S. – were asked about their beliefs, attitudes, and knowledge of heart disease. 45% of the interviewed women were unaware that heart disease is the number one cause of death in adult females across the States. Rather, nearly half of the participants thought breast cancer would be the number one killer, posing a greater risk to women’s health. In addition, the study found that “nearly 71 percent of women almost never raised the issue of heart health with their physician, assuming their doctor would raise the issue if there was a problem”.

The data, however, leaves no room for doubt. Cardiovascular disease is the leading cause of death among female adults in the U.S., claiming the lives of 1 in 4 women, or in other words, almost 400,000 people a year.

By comparison, breast cancer kills around 40,000 women every year – roughly ten times less. While the seriousnes of breast cancer must not be undermined or made light of, the reality is that the mortality risk associated with breast cancer has dropped in the last few decades. Awareness campaigns, diagnostic advances, and treatment breakthroughs have all contributed to declining death rates in women with breast cancer.

Heart disease in women, on the other hand, is not only more deadly in general but also remains harder to diagnose. In addition, it seems that women are less likely than men to receive adequate care for their heart-related health issues which further aggravates mortality rates. In this article, we will explore the reasons for this deeply disconcerting situation.

Deceiving Symptoms and Ingrained Inequities

The symptoms most readily associated with a heart attack are:

  • severe chest pain that can radiate down the arm or up to the jaw,
  • profuse sweating,
  • nausea, and
  • shortness of breath.

However, studies show that almost half of women suffering a heart attack do not experience chest pain (in comparison to only about 30% of men). In adult females, the symptoms are much more vague and do not really resemble the “acute-pain-and-collapse” scenario that fits the anecdotal view of the heart attack which permeates the popular culture.

Instead, the symptoms may include:

  • extreme fatigue,
  • pain that radiates to the back,
  • indigestion, and
  • sleep disturbances.

Such symptoms are harder to classify and to pinpoint to a particular cause. According to one survey, their nondescript nature is one of the reasons why many women experiencing these warning signs may not be aware that they are likely undergoing a heart attack.

To make matters worse, even medical professionals may sometimes misdiagnose a woman who is suffering a heart attack. In some cases, it may be wrongly diagnosed as reflux or an anxiety attack. Because of that, women are less likely to be immediately sent to the emergency room and receive lifesaving treatment.

The reasons for this situation appear to be two-fold. First, the symptoms do indeed look different in women than in men – and consequently may be harder to diagnose – because women are prone to a different type of heart attack. In men, the condition usually occurs due to a blockage in one of the major heart arteries. This is easier to spot with diagnostic procedures such as the angiogram.

Women, however, tend to suffer heart attacks due to problems with smaller arteries. According to Dr. Laxmi Mehta, a cardiologist at the Ohio State Wexner Medical Center, these arteries do not usually suffer from a plaque buildup – which is easy to spot on an angiogram – but rather loose flexibility and constrict too much, cutting off blood flow to the heart.

The second reason why women seem to receive a subpar treatment may be gender inequality. In the U.S., female doctors are still largely outnumbered by their male colleagues – with the numbers being 333,833 and 633,817 respectively. Some studies conclude that differences in the treatment of coronary disease may be traced back to a historical “disregard of women’s health problems that still may be operative today” and the fact that “procedures and therapies currently used have been developed predominantly or exclusively for men”. Other studies, while concluding that the bias does exist, noted that it explains “some, but not all” differences in “gender disparities in cardiovascular testing”. In any case, some changes within the medical community with regard to the diagnosis and treatment of cardiovascular disease do seem to be called for.

Never Delay Getting Help

Studies on cardiovascular diseases in women revealed yet another worrying trend. According to Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health, “women tend to delay seeking emergency care for symptoms of a heart attack such as pain and dizziness”. A difficulty to self-diagnose – already discussed in this article – may, in part, explain this issue. However, the other part of the problem is that at least some women may be hesitant to bring their worrying symptoms to the attention of their doctor because they don’t “want to look like hypochondriacs”. Neverthless, if experiencing symptoms such as those mentioned in this article – severe fatigue, shortness of breath, diziness or atypical chest pain – especially if they tend to worsen with exertion, a woman should not hesitate to see her physician or even to call 911. Dr. Mehta, the cardiologist mentioned above, highlighted how important it is to never underestimate such symptoms in the following way: “I’d rather be wrong and go to the ER than die at home.”

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