Whereas cardiovascular disease is still the number one cause of death in men and women in the United States of America, it may develop and present itself differently between women and men.

WOMEN AND MEN HAVE DIFFERENCES IN BIOLOGY

Men and women show different anatomy and physiology, from their lungs and brain to their muscles and articulations. Women and men also have variations in their cardiovascular systems. For example, women have smaller hearts and narrower blood vessels than men.

Because of these biological differences, cardiovascular disease may progress differently in women than in men. And yet, until recently, physicians have diagnosed and treated women with heart disease like men: with the same tests, procedures, and medications.

WOMEN AND MEN EXPERIENCE CHOLESTEROL ACCUMULATION IN DIFFERENT AREAS

A heart attack happens when cholesterol plaque accumulates inside the walls of the arteries and causes damage to major blood vessels.

Men usually develop this plaque buildup in the larger arteries that supply blood to the heart. On the other hand, women are more prone to develop this buildup in the microvasculature, that is, the smaller blood vessels of the heart. In addition, heart disease in both women and men is only partially related to cholesterol buildup.

Inflammation also plays a crucial role and may contribute to the differences we see in women with heart disease.

WOMEN AND MEN HAVE DIFFERENT SYMPTOMS AND SIGNS OF A HEART ATTACK

A heart attack does not always feel or look the same in men as in women. Men often come to healthcare providers with chest pressure.

Women also experience chest pressure (it is still the number one complaint), but they are more prone than men to report the following as well:

• Sweating
• Nausea
• Vomiting
• Feeling exhausted
• Pain spreading to the back, neck, throat, abdomen, arms, shoulders, or jaw.

WOMEN MAY HAVE DISEASES THAT IMITATE A HEART ATTACK 

Women are more susceptible than men to suffering from diseases that simulate a heart attack.

For example, women are more vulnerable to experiencing:

• A coronary spasm: a blood vessel closes and imitates a heart attack.
• A coronary dissection: the wall of a blood vessel ruptures.
• Takotsubo cardiomyopathy: an inflammatory response that causes the heart to enlarge after an emotional stressor, the broken heart syndrome.

Healthcare providers, clinicians, and physicians still under-recognize that heart disease is not identical in women and men. Therefore, it is generally a moment with more understanding and knowledge when a healthcare provider realizes how many alternative diagnoses to consider when diagnosing a female patient.

WOMEN AND MEN MAY HAVE DIFFERENT RISK FACTORS FOR HEART DISEASE

A woman’s reproductive background may affect her risk of developing heart disease. Specific ailments developed during pregnancy, such as preeclampsia and gestational diabetes, can be powerful predictors of future heart disease risk.

Several studies show that women in their forties and younger with endometriosis were three times more prone to develop a heart attack or chest pain or require treatment for blocked arteries than women without that condition in the same age group.

Women with preeclampsia, endometriosis or gestational diabetes should adopt heart-healthy lifestyle habits. In addition, familiarize yourself with the symptoms and signs of a heart attack and ask your physician or healthcare provider to assess your risk of heart disease.

It is advisable to learn about Cardiovascular Disease and pregnancy programs that provide specialized attention for women with cardiovascular disease before, after, and during pregnancy.

At Modern Heart and Vascular Institute clinics, our team of cardiologists and qualified healthcare providers team up to detect and change risk factors early to prevent heart disease before it develops.

WOMEN AND MEN REQUIRE DIFFERENT DIAGNOSTIC APPROACHES

When a woman goes to a healthcare provider with symptoms and signs of a heart attack, she may receive a different diagnostic approach than a man.

For example, if the physician suspects a heart attack, both men and women undergo a cardiac troponin (cTn) test, which records circulating levels of troponin. The test releases this protein into the blood when a heart attack has damaged the heart muscle.

Higher levels of troponin show higher levels of heart injury. But the clinical threshold that indicates a heart attack may differ between women and men.

Some women may experience a heart attack but are below the detection level. In addition, providers are just beginning to apply sex-specific thresholds for specific diagnostic tests.

However, another diagnostic test, cardiac catheterization, has long been the number one method for diagnosing a heart attack, but this screening looks for blockages in large arteries. Because women are more predisposed than men to experience more significant plaque buildup in smaller arteries, this test may not be suited to diagnose heart disease in women.

If a cardiac catheterization does not give physicians the expected answers, women should ask if other tests are appropriate. These tests may include a cardiac MRI to look for inflammation of the heart or intracoronary imaging to look inside the walls of the blood vessels within the heart.

At Modern Heart and Vascular, physicians will tailor diagnostic and treatment services to women. These services include intravascular ultrasounds that may better detect heart disease in women.

The practice has long been a provider of clinical care, research, and patient and provider education.

WOMEN AND MEN MAY REQUIRE DIFFERENT TREATMENTS FOR HEART DISEASE

 Medical healthcare providers have decades of experience treating the typical buildup of cholesterol plaque in the larger blood vessels of the heart. But there is a weaker understanding of how to treat plaque in the microvasculature or inflammation of the heart.

That said, a growing number of physicians are beginning to address treatment decisions with the understanding that women may benefit from therapies and treatments that are different from those used in men, from slight calibrations in pacemakers to variances in angioplasty.

Ultimately, clinical trials will better inform healthcare providers and physicians about treatment differences between women and men.