Why do cardiovascular problems affect women differently than men?

Women generally have higher heart rates and smaller hearts and arteries than men. This means that when it comes to heart disease, plaque builds differently within women’s blood vessels. Female hormones can also make arteries smaller, causing them to be more prone to blood clots or blockages and more difficult to repair.

Women can show different symptoms of a heart attack. For both men and women, the most common sign of a heart attack is chest pain or discomfort, but women can experience a heart attack without chest symptoms. They may experience shortness of breath, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue. Because symptoms in women can be less specific, they can be harder to recognize as danger signs.

Women may also experience different mental and neurological symptoms when they experience a blood vessel related injury to the brain such as a TIA (mini-stroke) – a problem in the blood vessels of the brain that causes a temporary decrease in blood flow to a certain brain region. Because women and men’s brains and blood vessels are slightly different in form and function, stroke and TIA symptoms can vary widely in women compared to men, depending on the part of the brain that is affected.

STATISTICS FROM WOMEN COMPARED TO MEN

According to the Heart and Stroke Foundation, the following are true, when comparing cardiovascular health between women and men:

• Women are five times more likely to die from heart disease than breast cancer.
• Heart attacks are more deadly for women, and women are more likely than men to suffer a second heart attack.
• In 2018, 45% more women than men died of stroke in Canada.
• Women who have had a stroke have worse outcomes than men; they experience lower levels of mental and physical well-being.

Explaining why these difference exist and what can be done to address them requires more research.

THE EFFECT OF RISK FACTORS

Some risk factors are a red flag for women. While men and women share most of the same risk factors, some of them, like smoking, diabetes, high blood pressure, and a family history of heart disease or stroke, may pose an even greater threat for women than for men. It’s also believed that estrogen protects against heart complications, but once estrogen levels drop during menopause, the risk of heart disease within women rises. And as women age they are more likely to have other conditions, such as diabetes, that can further increase risk and complicate a diagnosis.

Knowing your risk factors is the first step in prevention. For example, you can reduce your risk by having regular medical checkups and focusing on treatable risk factors like:

• High blood pressure – the leading cause of stroke. It important to know your blood pressure, have it checked yearly, and work with your doctor to lower it if it’s too high.
• Smoking – damages blood vessels and can lead to blockages.
• Diabetes – more than doubles your risk of stroke, so it’s important to work with your doctor to manage your diabetes.
• High cholesterol – increases the risk of blocked arteries.
• Physical inactivity and obesity – it’s important to say active and maintain a healthy weight and diet.

It’s also important to be aware of non-treatable risk factors like age, gender, race, and family history as they will play a role in determining an individual patient’s risk for heart disease and stroke. If you are unsure, speak to your health care practitioner about your risk factors, and possible lifestyle changes and regular screening options that can help lower your risk.

An echocardiogram, exercise stress test, and myocardial perfusion imaging are medical imaging tests that can evaluate heart function. For a detailed look at coronary arteries, your doctor might order computed tomography imaging. Magnetic resonance imaging can be requested to look at the blood vessels in the brain and for signs of a stroke.

Please visit these links for more information on signs of a stroke and signs of a heart attack.

REFERENCES

American Heart Association. (2020) “Stroke Risk Factors.” www.strokeassociation.org. Accessed January 29, 2020.

Canadian Women’s Heart Health Centre (2020) “What makes women different?” www.cwhhc.ottawaheart.ca. Accessed January 29, 2020.

Harvard Medical School (2018) “Don’t be fooled by TIA symptoms.” Harvard Health Publishing. www.health.harvard.edu. Accessed January 29, 2020.

Heart and Stroke Foundation (2019) 2019 Report on Heart, Stroke and Vascular Cognitive Impairment.  www.heartandstroke.ca. Accessed January 29, 2020.

Heart and Stroke Foundation (2018) Heart & Stroke 2018 Heart Report. www.heartandstroke.ca. Accessed January 29, 2020.