Heart Disease in Men and Women

6 Differences You Need to Know


Heart disease is one of the most common health conditions in adults today. However, the way that it presents itself in men and women can be incredibly different. Here are six ways its effects can vary across the sexes.  


By Anna Hill


Dr. Aaron Soufer headshot
Dr. Aaron Soufer
The Chattanooga Heart Institute at CHI Memorial

Heart disease is a highly prevalent health issue in the United States – in fact, it is the leading cause of death in the country and responsible for nearly a quarter of the nation’s deaths each year. However, medicine is always advancing, and the more we learn about heart disease, the better it can be both treated and prevented. As more research is done, medical professionals are increasingly finding that there are some vital distinctions in how heart disease not only presents itself in men and women, but that there are also key differences in risk factors and in how it should be diagnosed as well.


What Is Heart Disease?

The term “heart disease” actually refers to several different types of conditions. While the most common type is coronary artery disease (CAD), it can also mean a congenital heart defect, an arrhythmia (irregular heartbeat), heart attack, heart failure, or cardiomyopathy, which is an irregularity in the heart’s walls or muscles. 

doctor writing results in a Cholesterol test (lipid panel)

1. Differences in Biology

Dr. Alison L. Bailey Headshot
Dr. Alison L. Bailey
Chief of Cardiology,
Centennial Heart at Parkridge

It’s no secret that men and women have different physical characteristics, yet many people never stop to think that those differences extend all the way down to the cardiovascular system. Women’s hearts are typically smaller than men’s, and their blood vessels often narrower. This leads to women having a slightly lower cardiac output than men. These physiological differences can naturally lead to a variation of consequences when it comes to heart health in men and women; however, these differences are unfortunately under-researched in the fields of anatomy, physiology, and medicine. 


2. Differences in Cholesterol Buildup

High cholesterol can lead to buildup of plaque in the arteries and cause damage to major blood vessels, which can result in a heart attack. This plaque buildup is most often detected in the largest arteries that pump blood to the heart. Dr. Aaron Soufer, a cardiologist with The Chattanooga Heart Institute at CHI Memorial, explains that this buildup can happen differently in women. “Microvascular coronary artery disease occurs when there is disease in blood vessels that are too small to see on traditional studies. Because women are more likely to have microvascular disease, which is difficult to see on traditional imaging, providers may miss this diagnosis in their female patients,” says Dr. Soufer. 


3. Differences in Heart Attack Symptoms

The most common symptom of a heart attack is chest pain and chest pressure. However, a critical difference between men and women experiencing heart attacks is that women are far more likely to present with symptoms that are considered “atypical,” which might lead to them not being aware that what they’re experiencing is a heart attack. According to Dr. Alison L. Bailey, the chief of cardiology with Centennial Heart at Parkridge, “Women may have a wider range of symptoms that includes things like nausea, abdominal pain, fatigue, and shortness of breath more often than men.” While a heart attack can cause these symptoms in anyone, women experiencing them might not immediately suspect a heart attack.


4. Differences in Risk of Heart Attack-Mimicking Diseases 

When it comes to heart conditions, there are several that often imitate the symptoms of a heart attack, and women are far more likely to experience them. For example, women are more likely to experience the following: 

  • Broken heart syndrome: a condition that disrupts the heart’s normal pumping function in reaction to a severe emotional stressor
  • Spontaneous coronary artery dissection: when a tear forms in a blood vessel in the heart, which can slow or block blood flow

While the former can mimic a heart attack, the latter can not only mimic one, but eventually lead to one occurring, and both should be taken seriously. 

red blood cells

5. Differences in Risk Factors

Perhaps one of the most significant differences between men and women in regard to heart disease is the risk factors. Hormones and reproductive history can have a significant impact on heart health. For example, women who experienced preeclampsia or gestational diabetes during pregnancies, as well as women who have PCOS or endometriosis, are at a higher risk of developing heart disease later in life. Dr. Soufer explains that women’s higher risk of autoimmune disease can also affect their heart health. “Having an autoimmune disease, such as rheumatoid arthritis or lupus, can put someone at higher risk of heart attack and stroke due to the fact that these and other autoimmune diseases cause inflammation in the body that can affect the cardiovascular system,” he explains. “Women are at higher risk of autoimmune diseases than men, which is another risk factor for women regarding their cardiovascular health.” 

Furthermore, researchers have found that naturally occurring estrogen relaxes the walls of the arteries, which allows blood to flow easily. When women go through menopause, their levels of estrogen decrease, which can lead to a loss in flexibility in the arteries and therefore a higher risk of heart disease. This change due to menopause might also explain why women are more likely to experience heart attacks at a later stage in life than men.


6. Differences in Diagnostic Care

As healthcare advances, medical researchers are finding that there might not be a universal ideal when it comes to diagnosing heart disease in men and women. For example, one of the diagnostic tools to determine if someone is having a heart attack is a cardiac troponin (cTn) test – high levels of cTn can indicate heart damage. However, some women fall below the clinical threshold of the test, despite the fact that they are very much experiencing a heart attack. As mentioned previously, women are more likely to experience plaque buildup in their microvasculature, and such dysfunction is usually best recognized with positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) imaging. Unfortunately, these diagnostic tests have a lower availability than other, more traditional options, which could be a reason that heart disease is under-recognized in women.

Another obstacle that women face with diagnostic care is that they often go completely undiagnosed in general. “Women tend to not follow up with routine health visits in early life, and this is a time when a lot of early disease can be detected,” Dr. Bailey says.

Though heart disease is incredibly common, there are several steps you can take to greatly lower your risk. Take charge of your health by maintaining a healthy diet, exercising regularly, and refraining from smoking. You can also work alongside your doctor to monitor your blood pressure, cholesterol, and blood sugar. By being mindful of your lifestyle and keeping tabs on your health, you can reduce your risk of heart disease and increase your chance of many more healthy years to come.  HS

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