The message is inescapable.
Women have different cardiac symptoms than men.
Women get heart disease later than men.
Women may have a poorer outcome with angioplasty and heart surgery.
Women are different.“It’s true and not true,” says Kathleen M. Heintz, D.O., a clinical cardiologist at the Cooper Heart Institute. “Obviously the basics are the same—same chambers, same valves, and same types of vessels. The differences are much more subtle. They relate to age, and size, and the effects of certain hormones and external factors,” she added.
Why all the urgent messages now? Why do we seem to get new information and research everyday on women and heart disease?
“The problem has been that until the last decade, nearly all heart disease research was conducted on men,” says Perry J. Weinstock, M.D., Director of Clinical Cardiology at Cooper and past president of the South Jersey Chapter of the American Heart Association. “As more and more cardiac research is performed specifically on women, we are finding that there are differences that affect diagnosis, treatment and outcome.”
What are some of the differences that have been documented?
- Blood vessels in a woman’s heart are smaller and may develop more diffuse fatty build-up (atherosclerosis) than the arteries of a man’s heart. This difference may account for why women often do not have the crushing chest pain that men experience during a heart attack. In addition, the generally smaller vessel size in women may explain why research has shown that men have a better response to treatments, such as angioplasty or stent placement.
Studies show that women may present with complaints different from the classic symptoms that are associated with a heart attack. Women report experiencing extreme fatigue, sweating, dizziness, nausea, shortness of breath or referred pain into the jaw and neck.
- Women routinely develop heart disease 10 years later than men. Most researchers and clinicians relate this difference to the beneficial effect on blood vessels of natural estrogen produced by woman’s ovaries. However, the existence of diabetes will negate this beneficial effect. After menopause, research shows that women and men develop heart disease at the same rate.
- Research conducted on postmenopausal women has concluded that estrogen replacement therapy (ERT) taken after menopause does not provide the same beneficial effect as natural hormones. In fact, ERT may increase a woman’s risk of cardiac events, such as heart attack.
- Peripheral arteries (blood vessels throughout the body) also tend to be smaller and develop more diffuse atherosclerosis than men. Because of the smaller size, risk factors like smoking and diabetes may narrow vessels more quickly in women than men.
“The truth is that regardless of the differences, the facts are clear. More women than men will die this year of heart disease, and two-thirds of women who die suddenly do not have a history of cardiac symptoms,” Dr. Weinstock says. “The key then is to prevent disease.”
Dr. Heintz stresses the need for prevention and addressing risk factors. “Stop smoking now; the damage to the heart and lungs from smoking is beyond question,” Dr. Heintz says. “Other factors, such as diabetes, high cholesterol, high blood pressure, and obesity are risk factors that can be controlled, and their negative effects minimized. The goal should be to modify the risks that you can, as early as you can.”
If you are experiencing symptoms that could be related to your heart, see a doctor. If you want to make an appointment with a Cooper University Hospital physician, please call 800-8-COOPER (800-826-6737).