Many women may go through a heart attack and not even know it. There have been reports of women who thought that the symptoms they were experiencing were due to a cold, flu, or simply stress – when really, they were symptoms of a heart attack.
Cardiovascular disease and coronary heart disease are understudied, underdiagnosed, and undertreated in women. This is shown in health statistics. According to the American Heart Association, heart disease is the number-one killer of both men and women, but women are significantly more likely to die from a heart attack.
Within a year of a first heart attack, the mortality rate is 26% for women and 19% for men.
Within 5 years of a first heart attack, the mortality rate is 47% for women and 36% for men.
Within 5 years of a first heart attack, women are more likely to have heart failure or suffer from a stroke.
Why are women so much more likely than men to die from heart attacks? While we can only speculate the reason for this disparity between the sexes – there are a few reasons which may play a role.
Sociological Reasons
When at a hospital, women are more likely to die of a heart attack if they are getting treated by a male doctor.
In a study published in The Proceedings of the National Academy of Sciences, researchers studied the rates of survival/ mortality with patients who received treatment from a physician of either the same or the opposite gender.
While patients of female physicians had similar outcomes, independent of gender, the study found an increased mortality rate when male physicians treated female patients. Survival rate for female patients treated by male doctors was 1.52% lower than it was for male patients treated by female doctors.
This problem only becomes more serious when considering the majority of heart attack patients were treated by male physicians. In the study, 520,078 patients were treated by male doctors, while 61,719 were treated by female physicians – 8 times more patients received treatment from a male doctor, therefore putting female heart attack patients at an increased risk. The researchers also found that “male physicians with more exposure to female patients and female physicians have more success treating female patients”.
Why would women treated by male physicians be dying at a higher rate? One possible reason is because female heart attack symptoms tend to be subtler than in men. This may contribute to male doctors not immediately recognizing the symptoms, leading to a later diagnosis and poorer prognosis following a heart attack. When male doctors have more exposure to female patients, they gain familiarity with female symptoms and become better able to detect and diagnose heart attacks in women – making them able to treat the issue sooner. Another reason could be because women may feel more comfortable advocating for themselves (and not downplaying their symptoms) if they are being treated by a female doctor.
Further cause for the disparity in survival rates could be caused by a lack of representation – in both the media and scientific literature – for how women experience heart attacks.
Perpetuated by the Media
For a long time, hypertension, cardiovascular disease, and heart attacks have been thought of as “male” sicknesses – a serious risk for men, but not for women.
This assumption has been reflected in the media. In movies, for instance, the classic stock character — ‘the stressed and slightly overweight dad’ — is the one who has the heart attack. Because of the pervasiveness of this belief, women are less likely to think they are having a heart attack, so they are less likely to get the help they need soon enough. This dangerous assumption has also made its way into scientific research.
Scientific Reasons
While extensive cardiovascular research has been done for men, there has been significantly less research done for women.
“Despite some progress, women are still not being included in cardiovascular disease studies in adequate numbers, and many clinical trials do not analyze, or report results by gender,” said Nancy Brown, CEO of the American Heart Association (AHA).
The National Institute for Health wrote an article on “Gender Balance in Cardiovascular Research” and found that cardiovascular disease trials featured a test population consisting of 85% men and only 15% women. The women in these trials were also almost entirely postmenopausal, further limiting the breadth of research for women. Because of this research, there has been a significant improvement in understanding cardiovascular disease and treatment, but women’s mortality rate is still approximately 11% higher than in men.
Heart attacks have a different presentation in women than in men – with women sometimes experiencing more subtle symptoms. For instance, women are more likely than men to have symptoms unrelated to chest pain. Further complicating diagnosis, women who experience a heart attack may have more broad underlying health conditions.
A woman’s heart has some physical differences from a man’s – as identified by Carolyn Thomas, a Mayo Clinic-trained women’s health advocate.
Arteries: Women’s arteries are, on average, 1 mm smaller than men’s arteries. This difference can make some types of surgery much riskier for women.
Size: A woman’s heart weighs about 60 grams less than a man’s heart. Larger hearts can be easier for cardiologists to work with, so when a woman receives a transplant, for example, it’s usually a man’s heart. Dr. Marianne Legato of Columbia University explains that not only do women have smaller hearts and smaller arteries, but their hearts also beat faster, even during sleep.
Valves: Women’s valves are floppier than men’s, which may be why women are born with more valve disorders, such as mitral valve prolapse, a condition that affects about 6% of women and can progress to the point where the valve between the upper and lower left chambers no longer closes properly and requires heart surgery for repair or replacement.
Due to the longer time to diagnosis and smaller anatomical size of a woman’s heart, medical treatments may not be as safe or effective for women as they could be. Therefore, it would be beneficial to both men and women do more gender-specific research, so that heart health can be better understood, and more effective treatments can be developed.
Female-Specific Risk Factors
While some risk factors for heart health are the same in both men and women, there are a few female specific risk factors that can play a role.
Pregnancy complications: Women who experience high blood pressure during pregnancy, and the associated condition eclampsia, have a heightened risk of heart attack.
Hormonal Birth Control: Methods of birth control that involve taking hormones, such as in combination pills and estrogen-only pills may cause an increase in “bad” LDL cholesterol with a decrease in “good” HDL cholesterol, contributing to a build-up of plaque in arteries. Over time, this can lead to a blockage of blood to the heart and can cause a heart attack.
Early- or late- first period: New research suggests that women who experience their first period at age 10 or younger, or age 17 or older, are more likely to develop heart disease later in life.
Menopause: A decline in estrogen levels following menopause causes an increased risk in developing disease in small blood vessels, contributing to an increased risk for heart attack.
Both men and women can experience the well-known heart attack symptoms (including chest pain, cold sweat, and nausea), but women are far more likely to have subtler symptoms. On the website Go Red for Women, it states that when experiencing a silent heart attack, both female patients and their doctor (of either gender) are more likely to assume that it is nothing more than anxiety or stress. There have been reports of women only thinking that they merely had a cold or the flu when really it was a heart attack.
Warning Signs in Women
Here are some heart attack warning signs in women – according to the American Heart Association:
Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes or goes away and comes back.
Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Other signs such as breaking out in a cold sweat, nausea or light-headedness.
As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.
The American Heart Association advises that these symptoms shouldn’t be taken lightly; if you are experiencing any of the symptoms above, it is recommended to seek medical help right away.
For more information on heart attacks, causes, risk factors, symptoms, prevention measures, and treatments – please stay tuned for our upcoming article on Heart Attacks Explained.