CVD in Women
CVD has been thought of as a “man’s disease,” but it actually kills more women than men. Polls indicate that women vastly underestimate their risk of dying of a heart attack and overestimate their risk of dying of breast cancer. In reality, nearly 1 in 3 women dies of CVD, while 1 in 34 dies of breast cancer; although CVD typically does not develop in women younger than age 50, recent research suggests that the number of CVD deaths in women age 35-45 may be increasing.
The hormone estrogen, produced naturally by a woman’s ovaries until menopause, improves blood lipid concentrations and reduces other CVD risk factors. For several decades, many physicians encouraged menopausal women to take hormone replacement therapy (HT), which includes estrogen, to relieve menopause symptoms and presumably to reduce their risk of CVD. However, some studies found that HT may actually increase a woman’s risk for heart disease and other health problems, including breast cancer. Some newer studies have found that the increased risk of CVD in women who start HT may be age dependent; women in the early stages of menopause or ages 50-59 did not appear to have excess risk. This suggests that outcomes may depend on several factors, including the timing of hormone use. The U.S. Preventive Services Task Force and the American Heart Association recommend that HT not be used to protect against CVD.
When women have heart attacks, they are more likely than men to die within a year. One reason is that because they develop heart disease at older ages, women are more likely to have other health problems that complicate treatment. Women have smaller hearts and arteries than men do, possibly making diagnosis and treatment more difficult.
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Women presenting with CVD are just as likely as men to report chest pain, but are also likely to report other symptoms, which may obscure their diagnosis. These additional symptoms include fatigue, weakness, shortness of breath, nausea, vomiting, and pain in the abdomen, neck, jaw, and back. Women are also more likely to have pain at rest, during sleep, or with mental stress. A woman who experiences these symptoms should be persistent in seeking accurate diagnosis and appropriate treatment.
Careful diagnosis of cardiac symptoms is also key in avoiding unnecessary invasive procedures in cases of stress cardiomyopathy (“broken heart syndrome”), which occurs much more commonly in women than in men. In this condition, hormones and neurotransmitters associated with a severe stress response stun the heart, producing heart-attack-like symptoms and decreased pumping function of the heart, but no damage to the heart muscle. Typically, the condition reverses quickly.
Women should be aware of their CVD risk factors and consult with a physician to assess their risk and determine the best way to prevent CVD.