Women, Men, and Heart Disease

Susan McQuillan

Reviewed by QualityHealth's Medical Advisory Board

One in four women and one in four men in the U.S. die from heart disease. Equally frightening, almost half of all Americans have at least one of the top three risk factors for heart disease: high blood pressure, high LDL (low density lipoprotein, or "bad") cholesterol levels, and smoking. But while the statistics for men and women are similar, the way they experience heart disease can be very different.

Men, Women, and Types of Heart Disease

The most common form of heart disease, coronary artery disease occurs when the major arteries that feed the heart stiffen and become blocked by a build up of plaque, which is made up of cholesterol, fat, and other substances. This build up results in reduced blood flow to the heart, causing heart muscle damage, tissue death, and can ultimately lead to a heart attack. Though this type of heart attack occurs in both men and women, it is much more common in men. However, when women do have a heart attack, they are more likely to die within a year.

Coronary microvessel disease. Another form of heart disease is coronary microvessel disease, which affects the tiny blood vessels that also feed the heart. It’s more common in women than men. In some women, there’s no indication of blockage in the major arteries, but test results show that blood vessels are not functioning properly and blood flow is impaired. This may indicate coronary microvessel disease.

Sometimes a woman has both coronary microvessel and coronary artery disease, but only coronary artery disease is detected. Even if it’s treated, the patient may still experience symptoms and ultimately have a heart attack due to microvascular (blood vessel) damage that didn’t show up in the initial testing and was left untreated.

Heart disease differs in men and women in other ways, too: Women generally experience heart attacks later in life than men. This is thought to be due to protective levels of the hormone estrogen, which decline with menopause.

Additionally, high blood pressure leading to the stiffening of the heart muscle and eventually heart failure is more common in women.

Broken Heart Syndrome

Women also respond differently to stress: High levels of the hormone adrenalin and other signs of stress—sometimes triggered by an event—can lead to a condition known as "broken heart syndrome," (a.k.a. stress cardiomyopathy), a temporary disruption of normal heart function. Women with broken heart syndrome may have chest pain, and the symptoms may be mistaken for a heart attack—but it isn’t. The syndrome is treated with heart medications to help prevent further heart muscle problems. Most broken heart syndrome patients quickly and completely recover.

Heart Attack Warning Signs and Symptoms in Women and Men

Women often have subtle (and easy to overlook) early warning signs, such as fatigue and disrupted sleep during the month or two prior to a heart attack. In terms of symptoms, both men and women feel chest pain at the onset and during a heart attack, but men are more likely to feel a sudden and more crushing pain; they are also more likely to have a heart attack upon exertion. Women, on the other hand, may feel achy and uncomfortable due to tightness and pressure in the chest, but may not necessarily experience a great deal of sudden pain.

Other common heart attack signs that may occur more frequently in women include:

Shortness of breath
nausea
vomiting
pain spreading throughout the upper body

Prevention for All

What is similar for men and women are the preventive measures that can slow the progression of heart disease and heart failure. You’ve probably heard them all before, but they bear repeating:

Get regular medical check-ups, and if your physician prescribes medication for any condition related to heart disease, including high blood pressure, high blood fats, or diabetes, take as directed.
If you smoke, quit, and avoid secondhand smoke.
Identify and reduce stress factors in your life.
Avoid foods that are high in saturated fat, trans fats, cholesterol, sugar, and salt.

Finally, one of the most important things you can do to prevent heart disease is to stay active and maintain a healthy weight: "Getting at least 20 minutes of exercise each day goes a long way toward controlling other risk factors," says NJ-based cardiologist William Tansey, MD.

William A. Tansey III, MD, reviewed this article.