There is a widespread misconception that heart disease is a man’s disease. But in fact, cardiovascular disease (CVD), which can lead to heart attack, is the leading cause of death for women. Nearly 500,000 women will die this year from CVD, almost double the number of deaths caused by all cancers including breast cancer combined.Over 50% of people who have heart attacks do not have any conventional risk factors. Unfortunately for 46% of women, the first symptom of coronary heart disease (CHD) is a heart attack.

Men and women share many of the same risk factors but there are some important differences. 

1. Smoking is the #1 risk factor, but for women who smoke and take birth control pills, the risk of heart attack and stroke increases significantly.

2. Men pose a higher risk of CVD with elevated “bad” LDL cholesterol above 130mg/dl, whereas levels of “good” HDL cholesterol below 50 mg/dl are seen as greater warnings for women. 

3. After midlife, women tend to have higher blood pressure than men.

4. Metabolic syndrome triples the risk of a fatal heart attack in a woman and increases  her chance of developing diabetes 10 fold. The combination of abdominal obesity and high triglycerides are especially toxic for women.

5. A history of pregnancy complications was also added as nontraditional risk factors. These include gestational diabetes, pre-eclampsia, pregnancy-induced hypertension, pre-term birth or an infant born small for gestational age.

6. Depression and autoimmune disease such as lupus or rheumatoid arthritis are risk factors for women due to inflammation.

7. Stroke accounts for a higher proportion of cardiovascular disease events than CHD for women compared to men. Women have unique risk factors for stroke such as pregnancy, hormone therapy, and a greater prevalence of high blood pressure in older women. Why the difference?

In women, cardiovascular disease symptoms often have more to do with microvascular disease. This is a disorder of blockages in the smallest vessels which involves a narrowing of the microscopic tributaries of the coronary arteries.  In men, plaque creates lesions that bulge from vessel walls to form blockages inside the arteries. Heart attacks in men are more likely caused by plaque rupture. In women, heart attacks are more likely to be the result of plaque erosion. It is the health of the endothelial lining of the blood vessels that is crucial in determining a women’s risk for heart attack or stroke. Unfortunately, this condition is not seen when performing coronary angiography or treadmill stress tests.

Women often have “atypical” symptoms of CVD. It has now been recognized that shortness of breath is the most common presenting symptom of a heart attack in women over age 65. Also, most women do not complain of “typical” chest pain, but rather report nausea and vomiting or overwhelming fatigue. 

Reducing cardiovascular disease still includes exercise, optimal nutrition, eating more fruits and vegetables, not smoking, and weight reduction. 

I advise women to get a (CIMT) or Carotid Intima Media Thickness test. This is an ultrasound that measures the thickness of the inner lining of the carotid arteries where vulnerable plaque can grow. It is an independent predictor of risk for heart attack and stroke. I also recommend a low dose aspirin for women over the age of 55. 

Women need to be aware of symptoms and understand their unique risk factors for heart disease.