The Gender Differences of Heart Disease

For all the myriad differences between men and women, the gravest seems to be the divergence in how the genders experience heart problems -- specifically, heart attacks.

In women, heart attacks tend to occur later in life and are more severe.

"Women typically are around 10 years older when they have a heart attack, but they have more outside-of-the-hospital sudden cardiac death," says Jean C. McSweeney, a professor in the College of Nursing at the University of Arkansas for Medical Sciences.

"They are also more likely to die from the first heart attack and more likely to be disabled," she says.

Adds Dr. Nieca Goldberg, a cardiologist at Lenox Hill Hospital in New York City and spokeswoman for the American Heart Association:"There has been a misconception that women were immune to heart disease. Not only do women have heart attacks but they can be deadlier in women than in men."

"Younger women who have heart attacks have double the death rate compared to men the same age," says Goldberg, who is author of the book Women Are Not Small Men.

Such insights have led the American Heart Association to launch it's "Go Red For Women" campaign, designed to educate women about heart disease and how to reduce their risk. Heart disease is the No. 1 killer of American women, claiming nearly 500,000 lives each year.

One way to cut that risk: Know that warning signs of a heart attack can be very different in women than men.

In November, McSweeney published a study that identified several unusual early warning signs that appear to presage heart attacks in women.

The vast majority of the study participants (95 percent) reported experiencing new or different symptoms a month or so before their heart attack that went away after the attack. The most common symptoms were unusual fatigue (71 percent), sleep disturbances (48 percent), shortness of breath (42 percent), indigestion (39 percent) and anxiety (35 percent). About 44 percent of the women said the sleep disturbances were severe, while 42 percent described the fatigue as severe.

The most frequent acute symptoms were shortness of breath (58 percent), weakness (55 percent) and fatigue (43 percent).

Chest pain, long considered the classic heart attack symptom, was notably absent or was described differently by the women. Slightly less than 30 percent reported chest discomfort, but they described it as achiness, tightness or pressure, not pain. Forty-three percent reported no chest discomfort during the heart attack.

No one has yet to compare these findings to possible early symptoms in men. But since most of the previous research on heart attacks has been done on men, McSweeney says, "we assume the typical picture is more characteristic of men. This is the first time we have been able to get a typical picture of women."

What was particularly surprising was how early the signs appeared.

"We did not realize people were having these early warning symptoms as far out as they were having them. And that's very important for women, particularly because women are harder to diagnose than men," McSweeney says. "We think one of the reasons [for the difficulty in diagnosing] is that woman are having symptoms we haven't been looking for because they don't match the typical picture."

For women, stress testing is generally a better diagnostic tool than an electrocardiogram. Nuclear stress testing, which includes an imaging component, is even better, McSweeney says.

"Most of the diagnostic tests were developed with men and so, therefore, they're not quite as good as detecting diseases in women," she adds.

The bottom line is that doctors and patients alike need to be looking for different warning signs of heart attack in women.

"Traditionally, things uniquely female have not been emphasized," Goldberg says. "The only things uniquely discussed that were female were issues of breast or of the reproductive organs. After that, it was one size fits all."

McSweeney's study, published in Circulation, fits into a pattern of increased awareness on issues of female heart health.

"There is an increasing awareness and certainly the medical community is starting to embrace it by doing more investigation into the area," Goldberg says.

McSweeney and her colleagues are now working on a follow-up study that focuses on black and Hispanic women. Ninety-three percent of the women in her first study were white. "We are trying to get equal numbers [of blacks and Hispanics as whites]," McSweeney says. "We have reason to suspect there are racial differences."

"Many people in cardiovascular research and in the clinical area realize that women's death rates, the actual numbers, are increasing and that we have to do more research in this area," McSweeney says. "I'm very happy to say that it looks like more and more people are beginning to pay attention. We have a lot further to go but at least we're beginning to catch up."

More information

For more on women and cardiovascular disease, visit the National Heart, Lung, and Blood Institute.