Everything Women Need to Know About Heart Disease

From television show and movies, we know what a heart attack looks like: a sharp, shooting pain in your arm travels to your chest and has you collapsing on the floor within seconds. However, the truth of the matter is, heart attacks don't exactly look or feel like that for women.

While the most common presentation of coronary disease in both sexes is chest pain and discomfort, cardiologist Dr. Emily Ruden of the St. Vincent Medical Group in Carmel, Indiana says women show different symptoms from men, as theirs are more atypical than what their male counterparts present.

The American Heart Association says cardiovascular diseases and strokes affect more than 44 million women in the U.S., with Ruden adding that it accounts for 1 in 3 women's deaths every year, and is the number one killer of women.

"It is estimated that 90 percent of women have one or more risk factors for heart disease," Ruden says. "The encouraging news, however, is that a large proportion of heart disease and stroke events can be prevented with lifestyle changes."

What is heart disease?
Known as a condition that affects your body's heart and blood vessels, Ruden explains that the most common type of heart disease affecting women today, and perhaps even the most important to look out for, is coronary artery disease.

"In this form of heart disease, cholesterol builds up as plaque in your arteries," she explains. "If significant build up or blockage develops, it can affect blood flow to your vital organs, specifically your heart and your brain."

Ruden adds that if a blood clot forms in these areas, blood flow can be completely blocked, resulting in a heart attack if it occurs in your heart arteries — known as angina; or a stroke if it occurs in your brain."

Why do women suffer from heart disease more than men?
In a report from the American Heart Association, studies show women suffer more from heart disease than men do. Ruden says this trend has been evident since the 1980s, and although death rates from heart disease are on the decline for both men and women, the gender disparity remains.

"Within the first year after a heart attack, 26 percent of women will die compared to only 19 percent of men," Ruden says. "Within five years of a heart attack, more women will die than men, more will have heart failure, and more will suffer from a stroke."

Yet despite women facing a greater risk than men, Ruden points that they usually have less blockage in their major heart arteries than men, adding that researchers are now learning that in some women, the problem is not with the large heart arteries, but rather the tiny blood vessels that supply the heart (known as microvasculature), which is different from men.

Fellow cardiologist, Dr. Ashley Funk with the St. Vincent Medical Group adds that the incidence of coronary heart disease in women lags behind by 10 years compared to men, as women are generally older when they have their first event. Moreover, they usually have more health issues at the time of a heart attack, leading to complications like diabetes, heart failure, high blood pressure and kidney problems.

"It has also been shown that there can be delays in the initial identification and treatment of women presenting with acute coronary symptoms compared to men," Funk says. "Some of the reason for this may be related to sex-specific pathophysiology and anatomy that differs from that observed in men and potentially decreased awareness in women for the signs and symptoms of coronary disease."

Who is more at risk of developing heart disease?
The more risk factors you have, the greater your risk is developing heart disease. Funk says it's important to get screened if you present high risk factors, like family history, smoking, diabetes, obesity, a sedentary or inactive lifestyle, high blood pressure and high cholesterol.

However, not all risk factors are equal for women as Ruden explains smoking, diabetes, and emotional stress carry more weight than others, stating that smoking is a "big one" since it makes you seven times more likely to have a heart attack.

"The good news is that your risk of heart attack drops significantly within one to two years after stopping smoking," Ruden says, adding it's the single best thing to do for your cardiovascular health.

Additionally, Ruden adds complications during pregnancy, such as pre-eclampsia or eclampsia, can also be warning signs about your risk for developing heart disease. At this point, she encourages you to see a cardiologist early on if you suffer these conditions.

What are the symptoms?
Both cardiologists state the most common symptoms experienced include a central chest discomfort or pressure that may travel to your jaw, shoulder and arms, and may be associated with nausea, vomiting or sweating.

However, Ruden points out women are more likely to have atypical heart attack symptoms, which can lead to a delay in diagnosis and thus treatment. Atypical symptoms can include stomach, jaw or neck pain, and may be associated with nausea, fatigue, sweating.

"Sometimes the symptoms for women are much more subtle — unusual fatigue, unusual shortness of breath, indigestion, a sense of dread, or shoulder or arm pain without the chest pain," Ruden says.

What can we do to reduce our chances of developing heart disease?
Advising that heart disease is an important issue to pay attention to for ongoing research efforts with patient education and awareness to improve outcomes, Funk says that the key to reducing heart disease is prevention through early recognition and treatment of risk factors.

"All patients should be screened for risk factors by their primary care provider," she says. "When risk factors are identified, they need to be treated aggressively with either lifestyle modifications or medications when necessary."

Furthermore, Ruden says it's important for women to understand their risk as so many spend a considerable amount of time taking care of others and end up neglecting their own health. In addition to seeing your primary care doctor, she advises women to see the OB-GYN so that risks can be identified and treated timely.

"Your doctor will check for high blood pressure, high cholesterol, and diabetes and work with you to control or prevent these conditions," Ruden says. "We recommend 30 minutes of physical activity at least five days per week, combined with a well-balanced diet."


Understanding that meeting these requirements for prevention can be hard, especially as we juggle careers and family, Ruden says women must make health their top priority.

"Find ways to involve your entire family so that they can also learn the value of healthy living," she says.