Doctors have known for years that men and women experience heart disease somewhat differently. It’s long been clear, for instance, that before menopause, women are less likely to develop heart disease than men. This is thanks to the protection estrogen provides, and it’s a key reason why the average age for a heart attack is 64 for men but 72 for women. Women catch up quickly, though, making heart disease the leading cause of death for both sexes overall during non-pandemic times.
But new research is changing cardiologists’ understanding of heart disease in women. Take, for instance, the symptoms of a heart attack. With women, doctors have for some time been taught to look for “atypical” signs, including heartburn, back pain, or pain that is burning, stabbing or resembles indigestion. With men, they expect more “typical” symptoms, including chest, jaw or arm pain; pain that radiates to one of the arms, neck, jaw or back; and nausea, vomiting, sweating or palpitations. But recent research shows women are just as likely to experience the “classic” signs as men. A study of nearly 2,000 patients published recently in the Journal of the American Heart Association found that women’s most common symptoms were chest pain and aches radiating down the left arm.
This is just one of several recent findings — with more included below — that shed light on sex-related differences in the diagnosis and treatment of heart disease.
Younger women are at greater risk of death
Women have fewer heart attacks than men, but they tend to fare worse during them. To find out why, researchers at the Mayo Clinic in Rochester, Minnesota, examined hospital data on nearly 7 million heart attack patients. In a study published in January in Mayo Clinic Proceedings, they showed that women who are hospitalized with a heart attack are less likely than men to receive life-saving treatments, such as angioplasty, in which clogged arteries are opened, and mechanical circulatory support, in which devices are used to improve blood flow.
Lead researcher Mohamad Alkhouli, M.D., an interventional cardiologist at the Mayo Clinic, speculates that doctors may hold back on these treatments because they believe women won’t fare as well during such surgeries. The researchers also discovered that women under age 65 were more likely than men to die from a heart attack — especially when they suffer from a type in which the coronary artery is significantly but not completely blocked.
More menopause symptoms may mean more risk
While it’s long been known that the plummeting estrogen levels of menopause reduce the hormone’s protection of the heart, new research shows that greater suffering from menopause’s hot flashes or sleep disturbances may signal greater cardiovascular risks. When researchers from medical centers across the country followed more than 20,000 women ages 50 to 79 for a median of seven years, they found a link between having two or more moderate or severe menopause symptoms and increased risk of things like heart attack and stroke.