How Heart Disease Presents Differently in Women

Heart disease has long been viewed as a male issue, but in reality, it is the No. 1 killer of both women and men in the United States. To put it into perspective, one in 30 women dies of breast cancer each year, while a staggering one in four dies of heart disease. In fact, heart disease kills more women over the age of 65 than all cancers combined.

Nina Asrani, M.D., cardiologist and physician on the medical staff at Texas Health Fort Worth and Consultants in Cardiology, a Texas Health Physicians Group practice, says that while heart disease is indeed the leading cause of death in both sexes, women underestimate the danger.

“According to the American Heart Association, just over half of women surveyed in 2012 were able to identify heart disease as the leading cause of death in women,” she explains. “Cardiovascular disease will kill one woman every 80 seconds in the United States. It is a huge problem and can affect anyone.”

So, what is coronary artery disease (CAD) and why is it so deadly to women?

According to the American Heart Association, CAD occurs when plaque (made up of fat, cholesterol, calcium and other substances in the blood) grows in the coronary arteries, eventually restricting blood flow to the heart. Plaque buildup can lead to angina (chest pain), heart attack, heart failure, arrhythmias (irregular heartbeats) and sudden cardiac arrest. CAD can be chronic as arteries become narrow over time, or acute when plaque ruptures suddenly and forms a blood clot or thrombus.

Risk factors include the following:

  • High LDL cholesterol
  • Low HDL cholesterol
  • High blood pressure
  • Diabetes
  • Family history
  • Race (Heart disease risk is higher among African Americans, Hispanic Americans, American Indians, native Hawaiians and some Asian Americans.)
  • Alcohol and tobacco use
  • Stress
  • Advanced age (post-menopausal women and men ages 45+; CAD tends to show up in women on average 10 years later than in men.)
  • Obesity

While some of these factors can be modified, treated or controlled, others cannot. The best way to prevent CAD is to practice good nutrition, weight management and physical activity.

“It is estimated that 80 percent of heart disease can be prevented by managing the main risk factors,” Asrani says. “These include high blood pressure, diabetes, cholesterol, exercise, nutrition and smoking. Have your blood pressure checked regularly, as there are often no symptoms even when it is high. If it is running over 140/90, talk to your doctor and take medications if prescribed. Have your fasting blood sugar checked. An elevated value may mean diabetes, which is a big risk factor for heart disease, and needs to be treated if present.

“Know your cholesterol numbers and discuss them with your doctor to make sure they are within range. Physical activity reduces the risk of heart disease and even small amounts can help. A healthy diet reduces the risk of heart disease as well and quitting smoking is a must.”

While women have been focused on breast cancer over the past several decades, most heart education seems to be aimed at men. The danger arises when women don’t realize that signs and symptoms of CAD can be different in males and females, making it more difficult for women to detect.

Asrani explains that symptoms in women can be atypical, making it more difficult for the patient to detect.

“Heart disease may present differently in women,” she explains. “The ‘typical’ symptoms of heart disease include chest pain or pressure, especially if they happen more with activity and go away with rest. Women may be more likely to feel sharp or burning pain and have pain in the neck, jaw, arms or back. They may also experience shortness of breath, extreme fatigue or nausea.”

In an article published by the American Academy of Family Physicians, the author points out that angina is less predictive of CAD in women (50-60 percent) than in men (80-99 percent).

As such, a woman may not rush to the hospital because she doesn’t even know she’s having symptoms related to heart disease. The discomfort in her chest may not feel like the “elephant on the chest” like men often describe, but rather a burning, tightness or pressure. The feeling may alternately seem to be coming from the jaw, back, stomach or either arm (not just the left). Women in coronary distress usually report more symptoms, including the classics (shortness of breath, nausea and vomiting) and those that aren’t as common like fatigue, dizziness and palpitations.

The causes and presentation, diagnosis, treatment and outlook in women with CAD are indeed different than their male counterparts, but their need for care is the same. When seeking care for symptoms associated with cardiac issues, women are diagnosed less aggressively than men and may not receive the same diagnostic testing, monitoring or continued care.

Asrani recommends that women take stock of what is normal for their health so they can be aware when something changes.

“Women should know their numbers for blood pressure, blood sugar (for possible diabetes) and cholesterol, and talk with their doctors about their potential risk for heart disease,” she says. “It’s hard to do sometimes but is vitally important for women to make time for exercise and a healthy diet. Women often diminish their own symptoms or postpone taking care of things for themselves. It is crucial to put your own health first and listen to your body. If you have symptoms, take them seriously.

“Women are also uniquely positioned to improve not only their own health, but also the health of their entire families, by making changes to ensure a better diet and more exercise for everyone. This makes it even more important for women to be aware of the risk of heart disease and the benefits of a healthy lifestyle.”

Since 2011, Texas Health Resources has been the local cause sponsor of Go Red™ for Women, joining the American Heart Association in the fight against heart disease. To learn more, please visit TexasHealth.org/GoRed.

How Old is Your Heart?™ Find out by taking our heart risk assessment.

If you’re in need of a heart-health partner, the physicians on the medical staff at Consultants in Cardiology are here to help. Learn more about Nina Asrani, M.D., her colleagues, and the specialized cardiovascular care they provide by visiting, THPG.org/Consultants-in-Cardiology.

3 Comments

  • Sandra Norcross says:

    I am an over 65 Registered Nurse, who when practicing as a cardiac surgical nurse and later as an Health Promotion Coordinator, found heart disease in women one of my passions. I applaud Dr. Asrani and her colleagues for raising the awareness of women and heart disease. If you ever come to Denton to speak, please let me know. Thank you!

  • Denice Taylor, THAM says:

    Excellent article!

  • Kendal Benson says:

    Dr. Asrani is an amazing woman. Her and two other doctors saved my life in 2015 when was diagnosed with periosteum cardiomyopathy. She has been my cardiologist ever since. If you need a great cardiologist, look no further. She is amazing. Literally, a life saver. Thank you Dr. Asrani!

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