Heart attacks were once considered a man’s disease. Historical posters that educated women about heart health focused on how women could recognize heart attacks in their husbands, as noted by the American Heart Association (AHA). And women were not often included in studies of heart health and disease.
But modern research now shows that heart disease is the number one killer of women, according to the AHA. And heart attacks can affect women at younger ages than expected.
“Breast cancer gets a lot of attention, but heart disease kills more women than all cancers combined, so we’re trying to help people understand that this is not a man’s disease,” says Whitney Coppolino, MD, a Mass General Brigham cardiologist who specializes in women’s heart disease. Dr. Coppolino cares for patients at Massachusetts General Hospital.
Dr. Coppolino wants younger women to understand the unique risk factors and causes of heart attacks. She encourages all women to participate in heart health research. And she aims to educate women about the signs of a heart attack, which can be different for them than for men. This information can help you get the right treatment as soon as possible to improve your outcomes.
Women share the well-known risk factors for heart attack, such as:
But women’s heart disease also involves unique, specific risks, including:
Hormones are the biggest factor when it comes to gender differences in heart attacks, Dr. Coppolino says. The hormone estrogen has protective effects for the heart, but during menopause, your levels of estrogen decrease. In addition, menopause occurs at a time when other risk factors are increasing. For example, increasing body weight, blood pressure, and cholesterol levels.
Women who are pregnant or who have recently given birth are at particular risk for heart complications. There is an increased risk of cardiac disease in pregnancy.
“When you’re pregnant, your blood volume goes up, your vascular resistance goes down, and there is huge stress on the cardiovascular system,” Dr. Coppolino says. “We’re built for it, and we generally do well with it, but when we don’t, we get things like gestational hypertension and gestational diabetes. These can be red flags that you are at increased lifetime risk for cardiovascular disease.”
There is growing awareness of one particular condition for childbearing women: peripartum cardiomyopathy. This rare condition causes heart muscle to weaken during pregnancy or shortly after giving birth.
Many women have high and sustained levels of stress, which can affect heart health.
“This is a huge problem, especially for women. We tend to have a million plates spinning in the air at one time: family life, work life, aging parents, kids. It’s hard to balance,” Dr. Coppolino says. “What many people don’t realize is that these stress levels are pro-inflammatory. The body reacts to stress by releasing inflammatory chemicals that can damage your blood vessels and contribute to cardiovascular issues.”
In extreme cases of physical or emotional stress, some women experience stress-induced cardiomyopathy, also known as “broken heart syndrome.” This involves a rapid weakening of heart muscle.
Spontaneous coronary artery dissection (SCAD) affects women much more often than men. In SCAD, an artery wall suddenly tears, leaking blood and potentially causing a heart attack. SCAD often affects otherwise healthy younger women who have no other risk factors. Therefore, emergency personnel might not immediately recognize it as a heart attack.
During a heart attack, it is essential to get treatment early to save as much heart muscle as possible. However, Dr. Coppolino says, women tend to seek treatment later in the process. Later treatment leads to worse outcomes for women, including:
One of the reasons is that the signs of heart attack in women differ from what they may expect.
“The classic presentation of a heart attack is chest pain, or the feeling that there is ‘an elephant on my chest,’ Dr. Coppolino says. “Women can still have that symptom, but they often have atypical symptoms, which often happen upon exertion.”
Signs of women’s heart disease may include:
“Women are good at knowing their bodies, we just have to trust ourselves and seek treatment when something doesn’t feel quite right,” Dr. Coppolino.
Dr. Coppolino wants women to understand that even if they have some risk factors for heart attack, they are not destined to have one.
“Genetic predisposition and some of these risk factors — you can’t change it. But if you have these nonmodifiable risk factors, studies show that if you do all the other things in your power, you can mimic the person who does not have those risk factors,” Dr. Coppolino says.
To reduce the risk of heart disease and prevent heart attacks in women and men:
“Take the time to take care of yourself,” she says. “It doesn’t take that long, 10 minutes at a time, but it can make a big difference.”