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Coronary Heart Disease
|Are There Differences?
Yes. The symptoms of coronary heart disease (CHD) can present differently in women and men. For example in women, angina attacks may be the first sign of CHD whereas for men it can be a heart attack. Also women do not seem to do as well as men after taking clot-busting drugs or undergoing certain heart medical procedures. Why these differences should exist is the subject of many clinical trials. Research is only now beginning to uncover the biological, medical and social reasons behind these differences. The hope is, as more information comes to light, this will lead to advances in tailoring prevention and CHD treatment for women.
What Are The Differences?
Premenopausal women who do not have diabetes or smoke rarely develop CHD. This may be because while they still have a menstrual cycle their ovaries are producing estrogen. Natural estrogen appears to slow down the development of atherosclerosis (fatty deposit buildup which clogs the arteries) as well as helps keeps cholesterol levels lower. When menopause begins however, the body starts producing less estrogen and heart attacks in women become more common. Read more about how menopause affects the body.
As estrogen appears to play a protective factor, women tend to develop CHD on average 10 to 15 years later than men. This is why heart disease is sometimes considered a 'male' disease, although of course hundreds of thousands of women die from it every year. They just happen to die at an older age. And being older when CHD occurs has its own set of problems. The older a person is, the longer it takes them to recover from heart attacks and the more likely they are to have developed other health conditions which complicate matters. Ensure you read about recommended health screenings for women.
This is a group of conditions which increases a person’s chance of developing heart disease, diabetes and stroke. It includes high blood pressure, large waist size, glucose intolerance, low levels of the 'good' HDL cholesterol and high levels of 'bad' triglycerides. Metabolic syndrome seems to be the biggest risk factor for causing heart attacks in women at an unusually early age. It also puts women at greater risk for recovery after bypass surgery than men.
Heart Attacks Are More Life Threatening
Heart attacks tend to be more severe in women than men. Women are twice as likely to die within 12 months of a heart attack. Even if they recover, within 6 years they are twice as likely as men to have another heart attack.
Women have different symptoms to men when they are having a heart attack. Although both sexes may report classic chest pain, men are more likely to report severe pain which radiates down the arm. Chest pain in women is more likely to feel like a discomfort in the chest. Women are also more likely to suffer atypical heart attack signs such as back pain, fatigue, shortness of breath and sleep disturbances - all of which make it harder for both the woman herself and her doctor to identify that a heart attack is taking place.
Diagnostic Tests Less Accurate
Some heart disease testing equipment can be less accurate in identifying blocked arteries in women than men. For example, an treadmill stress test using electrocardiogram can give a high proportion of false positive results in younger women. This may be because most diagnostic equipment only used men in the original trials (again because of the myth that CHD is a 'mans' disease). Fortunately, these problems are disappearing due to advances in technology and a better understanding of women and heart disease.
People with diabetes are more prone to developing CHD but diabetic women are more likely to die from CHD than their male counterparts. This may be because female diabetics are more likely to have other risk factors such as hypertension, obesity and high cholesterol. Although women are generally protected from heart disease before menopause, diabetes erases that advantage. In women who have already had a heart attack, diabetes doubles their risk for a second one, and increases their risk of congestive heart failure (where the heart starts failing).
Treatment For CHD: The Differences Between Men and Women
Consistent studies show that men and women are cared for differently when they seek medical help for cardiac problems. Specifically:
When a woman is assessed for her risk factors for heart disease, she is much more likely to be assigned to a lower risk category than a man. As a result, she is less likely to receive coronary heart disease prevention advice. In fact many women say their doctors never talk to them about coronary risk. Furthermore many doctors are still not aware of the atypical female symptoms of heart attacks, wrongly diagnosing them as anxiety or indigestion. Furthermore, there is a lack of awareness among women themselves as to their risks. In a survey by the American Heart Association, while about 50 percent of women know that heart disease was the leading cause of death in women, only 13 percent felt it was their greatest personal health risk. On a day to day basis, women feared breast cancer more, even though heart disease kills 6 times more women. Why a disconnect? Heart disease tends to occur later in women, so a 50 year old woman is more likely to know someone who has breast cancer, than heart disease. This makes the threat of breast cancer feel more real. Also, breast cancer affects a woman's self-image and personal esteem in ways that heart disease cannot. All women should inform themselves about the causes of coronary heart disease.
Women tend to wait longer before going to an emergency department to report heart attack symptoms, possibly because their signs are less typical than men. However when they do arrive in hospital, they are more likely to be sent home with a diagnosis of something else, such as anxiety or indigestion. Men on the other hand are more likely to be diagnosed correctly and instantly treated with life saving treatments such as thrombolytic therapy or coronary angioplasty.
While certain tests are not as accurate for women, others like echocardiogram (echo) work just as well in women and men. Yet, an echo is less likely to be ordered for a woman.
Historically coronary bypass surgery has had higher risks for women than men, usually because women are older when it is required. Furthermore, women have more difficulties recovering from surgery due to their average advanced age. Also, by the time the surgery is required they are more likely to be widowed so they have less support and help and home to aid the recovery process. While coronary angioplasty and stenting is as valuable for women with a coronary heart disease diagnosis, the procedure may be more problematic because they tend to have smaller arteries. If you would like to learn more about CHD, check our list of books on heart disease for a list of resources.