While it’s been four decades since the first research on heart disease in women began, there’s still a prevailing misconception that women are less prone to heart disease compared to men.
In reality, heart disease has been the leading cause of death for both men and women in the United States since 1921. Today, over 60 million women in the U.S. are living with some form of heart disease, and it’s responsible for about one in every five female deaths.
For a long time, doctors considered heart disease a man’s disease, leading to a “historical myth that women weren’t suffering the same way as men,” said Dr. Aga Silbert, a clinical cardiologist at UW Health and a clinical assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health.
Even now, the risk of heart disease in women is often underestimated due to the misperception they are “protected” against cardiovascular disease since women usually don’t develop heart disease symptoms until about 10 years later than men. However, women can still develop heart disease as early as their 20s, though it’s less common.
There’s a more recent misconception that women have different heart disease symptoms compared to men, but they simply report them differently, Silbert said. Chest pain is the most common heart attack symptom in both men and women, but women will often report their symptoms differently because they are more likely than men to have symptoms that may seem unrelated to a heart attack, such as nausea and brief pain in the neck or back.
Unrelated symptoms make it difficult for women to recognize that they’re having a heart attack since they’re more likely to attribute symptoms like nausea and brief pain to non-life threatening conditions like acid reflux or the flu. Since women may miss the initial warning signs, they are more likely to delay treatment on their own compared to men, Silbert said.
Women often describe heart attack chest pain as pressure or tightness or they experience no chest pain at all, so the heart attack is the first warning sign. When it comes to heart disease in women, there are just “not as many red flags,” Silbert said.
Medicines, angioplasty and stenting or coronary bypass surgery are all heart disease treatments for men and women. But women are less likely to receive these treatments compared to men. Doctors are often more hesitant to prescribe medications to women, fearing they may experience greater side effects or have more difficulty tolerating them, Silbert said.
Women are also less likely than men to have coronary artery bypass surgery because they have a less obstructive disease or smaller arteries with more small vessel disease, according to Mayo Clinic.
Recovery programs are just as important as heart disease treatments. Cardiac rehabilitation treatments following heart disease treatment in women can make a huge difference in women’s survival, Silbert said. Unfortunately, lack of awareness of programs, transportation difficulties, exercise concerns and fear of a mixed-gender environment often discourages women from seeking cardiac rehabilitation treatment.
“Only about 50% of women that should be receiving [cardiac rehabilitation] are going, and only one in three women completes this program that is kind of life saving,” Silbert said.
Ideally, women should start building appropriate lifestyle habits at a young age to avoid developing risk factors for coronary disease, Silbert said. Heart disease prevention in women is all about being proactive.
“Exercise, healthy nutrition and psychological well-being that is supported by stress management all play a role in preventing future heart events,” Silbert said.
During pregnancy, women are especially vulnerable to heart disease. Pregnancy complications such as pre-eclampsia, gestational diabetes and gestational hypertension that result in high blood pressure can all increase women’s risk of developing cardiovascular disease in the future.
Only about 40% of women in the U.S. are at optimal health prior to their pregnancy, so even at a young age women can be at risk for heart disease, Silbert said. High blood pressure is common during pregnancy and postpartum, and at least 20% of new mothers in Wisconsin have high blood pressure which, if left uncontrolled, can lead to seizure, stroke, organ damage or even death.
Other risk factors include high blood pressure, high cholesterol and diabetes, and according to Silbert, recognizing these conditions and treating them as soon as possible is the best way to prevent heart disease. Being aware of warning signs like shortness of breath, chest tightness and tiredness, as well as underlying conditions, are key to preventing heart disease.
“Unfortunately, not all the disease can be prevented, and women have to be kind of diligent in their assessment,” Silbert said.
Historically, finding women to participate in heart disease research was more difficult than finding male participants since researchers were concerned that pregnancy could affect results, which further disincentivized using women in heart disease research.
“Legally, it was a little bit more difficult to recruit women because of the childbirth period,” Silbert said. “It was just not as convenient to conduct research like that when you had to worry about women potentially getting pregnant.”
Until the mid-1980s, women were left out of heart disease research, and the treatment and prevention for heart disease in women was based on male data. However, research is crucial for understanding the different causes, treatments and symptoms of heart disease in women.
“The only way to address a problem is by studying it, understanding what's the root cause of it and then obviously addressing it, so having as much data as possible is just kind of necessary for that,” Silbert said.
Advocacy work and education has helped increase awareness of coronary disease in women, but Silbert believes there is still work to be done.
“The problems with the discrepancy in health care between men and women as far as cardiovascular health is concerned is not a new concept,” Silbert said. “It has been going on for a good 15 years now, step by step, so the awareness, it's like a wave.”
February is American Heart Month, and it focuses on raising awareness about heart disease and encouraging people to take steps to improve their cardiovascular health.
“Yes, it would be optimal if we wouldn't need a February to get this done, if everybody was talking about it all the time,” Silbert said. “But the reality is, there's a lot to talk about, so making time for it and sort of emphasizing it, I think it's a good idea.”
