Why women are more likely than men to die of heart attack

Women develop heart problems later in life than men -- typically seven or eight years later and are more likely to have chronic coexisting conditions. By age 65, a woman’s risk is almost the same as a man’s.

Women are six times as likely to die of heart disease as of breast cancer.

Yet too few women, and even some doctors, recognise the unique warning signs. Women account for nearly half of all heart attack deaths.

Worldwide, 8.6 million women die from heart disease each year, accounting for a third of all deaths in women.

Just like the physical, psychological and emotional differences between men and women, there are differences in how women and men respond to a heart attack.

Women are less likely than men to believe they’re having a heart attack and more likely to delay seeking emergency treatment.

Risk factors for women
  • 71% of women experience early warning signs of heart attack with sudden onset of extreme weakness that feels like flu, often with no chest pain at all. Medical professionals should respond to women’s milder symptoms.
  • Smoking, diabetes and abnormal blood lipids erase a woman’s oestrogen protection.
  • Women who smoke risk having a heart attack 19 years earlier than non-smokers.
  • Women with hypertension are 3.5 times more likely to develop coronary artery disease (CAD) than women with normal blood pressure. High blood pressure is more common in women taking oral contraceptives, especially in obese women.
  • Women with diabetes have more than double the risk of heart attack. Diabetes also doubles the risk of a second heart attack in women, but not in men. Diabetes affects many more women than men after the age of 45.
  • Pregnancy. The normal circulatory and hormonal changes of pregnancy may cause women to become hypertensive for the first time, especially in the last three months. The hypertension usually disappears after delivery. When it does not, women should be sure to keep their blood pressure under control with medication, if necessary, and under the guidance of a doctor.
  • Low levels of oestrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease).
Warning signs

The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it’s not always severe or even the most prominent symptom, particularly in women.

Many women tend to show up in emergency rooms after much heart damage has already occurred because their symptoms are not those typically associated with a heart attack.

Women are more likely than men to have signs and symptoms unrelated to chest pain, such as:

  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks. This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease.

Women versus men

• Women develop heart problems later in life than men -- typically seven or eight years later and are more likely to have chronic coexisting conditions. By age 65, a woman’s risk is almost the same as a man’s.
• Metabolic syndrome — a combination of fat around the abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than men.
• Mental stress and depression affect women’s hearts more than men’s.
• Women wait longer than men to go to an emergency room when having a heart attack and physicians are slower to recognise the presence of heart attacks in women because “characteristic” patterns of chest pain and EKG changes are less frequently present in women.
• Men’s plaque distributes in clumps whereas women’s distributes more evenly throughout artery walls.
• Women are more likely than men to die after a first heart attack, and for survivors, there is a higher risk of recurrent heart attacks, heart failure, or death.
• Women are two to three times as likely to die following heart bypass surgery. Younger women aged 40-59 are up to 4 times more likely to die from heart bypass surgery than men the same age.

Prevention
  • Reduce saturated fats
  • Eat more fish, fruits, vegetables, nuts and fiber
  • Regular health checkups.
  • Do not skip meals.
  • Balanced diet.
  • Practice yoga, relieve stress.


Dr Ponith is the Resident Cardiothoracic Surgeon at The Karen Hospital

In the headlines