5 Things Women Need to Know About Their Heart
Women are often said to have big hearts, or soft hearts, or hearts of gold.
But with cardiovascular disease in women trending nearly as high as in men—and heart disease responsible for one in five female deaths in the U.S.—it becomes more and more essential that we emphasize elements that truly make the female heart unique.
Historically, women were not believed to be at risk for heart disease, so research studies tended to completely overlook the female heart. As a result, over time, women have been less likely than men to:
- Receive prescribed statins or have their blood pressure managed in conjunction with healthy lifestyle changes like exercising and quitting smoking
- Receive standard cardiovascular therapies or counseling
- Receive implantable cardiac defibrillators
- Get an early diagnosis of diseases such as microvascular angina, spasm, stress cardiomyopathy, and pregnancy-related cardiovascular disease
- Receive follow-up care and continued management of risk factors
As an advocate for preventative cardiology, I’d like to share five things every woman should be aware of to help maintain optimal heart health:
1. Women’s Hearts Are Different from Men’s
Gender can affect how certain risk factors impact an individual’s heart and can be a predictor of potential outcomes when heart disease is diagnosed. Here are a few key differences between the male and female heart:
After puberty, a man’s heart acquires greater muscle mass than a woman’s—growth of about 15% to 30%, based on his body size. In contrast, a woman’s heart is typically ⅔ the size of a man’s. And a woman’s heart rate is generally faster, so her heart works harder than a man’s over a lifetime.
In both men and women, as they reach their later years, the heart begins to lose muscle mass—in essence, remodel itself. But men and women are prone to differing types of heart diseases as the heart ages.
For instance, some older women are more likely than men to develop a stiff left ventricle, a condition called heart failure with preserved ejection fraction (HFpEF). Although this condition can be managed, older women need to be aware of their risk factors for heart disease, including high blood pressure, lack of physical exercise, excess weight, diabetes, and kidney problems. The best preventative approach to HFpEF: stay physically active and keep blood pressure under control.
Cardiologist Dr. Harjit K. Chahal covers five important things that women need to know about their hearts. https://bit.ly/3oCIkKb via @MedStarWHC
2. A Woman’s Heart Attack May Not Resemble a Man’s
In women, research shows that heart attack (myocardial infarction, or MI) does not necessarily follow the pathway of clot formation in a single blood vessel that we typically see in men. Women are more likely to be older and have diabetes when they experience a heart attack and thus are more prone to have non-classic or atypical symptoms and three-vessel disease in which the major blood vessels supplying the heart muscle are blocked or damaged. Women are also more likely to suffer complications from MI such as cardiac rupture or bleeding complications, a higher 30-day mortality rate, and a higher risk of recurring MIs.
Because women’s MIs can differ physiologically from men’s, certain heart conditions predominate in women, for example:
- Non–obstructive coronary arteries (MINOCA)
- Coronary artery spasm
- Micro-ruptures of eccentric clots
- Stress-induced cardiomyopathy caused by a life-altering event such as divorce, loss of a child, or financial distress
Most people are familiar with the idea of the classic, chest-crushing pain of a heart attack, and it remains the most common symptom of MI for both genders. But women may experience minimal or atypical warning signs instead. Signs of female heart attack can include symptoms such as:
- Unusual upper body discomfort (for example, in the shoulders or neck)
- Shortness of breath
- Breaking out in a cold sweat
- Unusual or unexplained fatigue
- Light-headedness or sudden dizziness
- Nausea or vomiting
The danger in not recognizing symptoms of cardiac distress: women may postpone getting treatment. When your heart muscle is in distress, time is muscle! Every second you wait means additional destruction to the heart, so it’s imperative to call 911 and seek medical attention, without delay.
The longer that treatment is delayed, the less likely the heart muscle will fully recuperate. I urge women, especially those who are older than 50 or have diabetes, to be aware of these non-typical symptoms of heart distress and head to the Emergency Department right away if you believe you could be having a heart attack.
3. Women Are More Prone to Small Vessel Disease
Women typically have a smaller body frame than the average man. This means their blood vessels are smaller, with a higher potential to develop small vessel disease.
Common risk factors for small vessel disease are smoking, diabetes, and inflammatory diseases such as lupus and psoriasis. These risks can damage the walls of the small vessels, causing harmful effects like coronary artery spasm.
Exercise is especially beneficial to strengthen smaller blood vessels. It keeps the endothelial lining of the vessels healthy and less likely to break or collapse. And, over time, exercise encourages growth of additional small blood vessels to supply blood to the muscles and heart.
4. Pregnancy Can Affect a Woman’s Heart
Did you know that pregnancy is the most metabolically challenging thing a body can do? A Duke University study showed that it is, in fact, 2–4 times more demanding than running from one end of the United States to the other!
Pregnancy is like a stress test for a women’s heart. An expectant mother’s blood volume nearly triples, her blood pressure changes, and her heart size and stroke volume increase.
A normal healthy woman is typically able to handle the physical stress that pregnancy places on her body. But if she develops health issues during pregnancy, she may find herself at higher risk of heart failure, coronary artery disease, hypertension, or diabetes later in life.
For example, if an expectant mom experiences an adverse pregnancy outcome (APO) such as preeclampsia (high blood pressure), preterm birth, or gestational diabetes, that APO can alter her microvasculature—even if the symptoms eventually disappear. This, in turn, can cause adverse cardiovascular remodeling—changes in the heart and blood vessels—putting the mother at increased risk of developing heart disease later in life.
Rare but very serious developments that can occur in normal, healthy pregnant women are spontaneous coronary artery dissection (SCAD), where the coronary artery tears, which can lead to heart attack, arrhythmia or sudden death, and peripartum cardiomyopathy (or postpartum cardiomyopathy), which is heart failure immediately before delivery or up to six months after giving birth.
Myocarditis—inflammation of the heart muscle—can also occur in pregnant women. And pregnancy may present risks for women with pre-existing conditions such as a heart valve issue or genetic issues like Marfan syndrome.
Also, Hispanic and Black women have higher APO rates than the general population. If you or someone you love has experienced an APO, it’s important to follow up with a cardiologist.
5. Women’s Hearts Are at Greater Risk after Menopause
Several risk factors for heart disease increase after menopause. Weight gain and lack of physical activity are more commonplace in post-menopausal women, which can affect the condition of the heart.
Particularly around the time of menopause itself, blood pressure may spike as well, even in women who’ve always had normal or low blood pressure. Other emerging risk factors for women’s heart disease include early menopause and depression.
In the past few years, there has been much discussion about hormone replacement therapy (HRT) and its potential effect on a woman’s heart. Traditionally, we think of estrogen as cardio–protective, and HRT aims to replace estrogen lost due to menopause. However, studies and observation have found no real benefit from HRT in reducing the risk of cardiovascular events. In fact, 10 to 15 years of HRT may actually increase a woman’s risk of developing blood clots and stroke.
Prevention Is Key
The Centers for Disease Control tell us that 80% of cardiovascular disease is preventable. Some preventative tips:
- Be aware of the risk factors for heart disease in women: high blood pressure, diabetes, smoking, a history of polycystic ovarian syndrome or previous treatments for cancer (such as chemotherapy for breast cancer or radiation therapy for Hodgkin’s lymphoma) and discuss them with your doctor.
- Seek preventative care from a cardiologist, particularly if there is a family history of heart disease.
- Know your numbers—cholesterol, blood pressure, body mass index (BMI), waist circumference, and A1C (a blood test for people with type 2 diabetes and prediabetes). After age 50, consider getting a non-invasive coronary calcium score–an inexpensive test that reveals early evidence of plaque buildup in the arteries.
Adopt a heart-healthy lifestyle. Make yourself a priority. Consume a diet that’s enjoyable but healthy and nutritious. Get moderate-to-high-intensity exercise for at least 30 minutes, five days a week. Reduce stress. And be sure to get adequate, restful sleep.
When I talk with my patients, I suggest:
“Follow my advice for six weeks. Use the medication I prescribe for you, eat healthy, and exercise. When you visit me again in six weeks, if you’re not feeling better and your heart health hasn’t already shown signs of improvement, you can go back to your old ways.”
So far, no one has.
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