Heart Disease Gender Gap: What You Need to Know

Did you know that about every 34 seconds, someone in the U.S. has a heart attack? But did you also realize that heart disease is the number one killer of both men and women, despite the fact that their heart attack symptoms can be very different? 

“The disparities between men and women for heart attack treatments and survival still exist. Unfortunately, many women have not yet gotten that message,” says Deborah Sundlof, DO, with LVPG Cardiology–Muhlenberg and Co-Director of the Women’s Heart Program with Lehigh Valley Heart and Vascular Institute.

That awareness includes understanding the risk for diseases like breast cancer vs. heart disease.

While one in 27 women will die from breast cancer each year, one in three women will die from heart disease. “That’s why it’s very important for women to be aware of their risks for cancer. But it’s also very, very important for them to be aware of heart health as well,” she says.

Heart attack warning signs: Understanding the differences

Heart attacks occur when blood flow that brings oxygen to the heart muscle becomes severely reduced or completely cut off due to a buildup of fat, cholesterol or other plaque. Spotting a heart attack and getting treatment quickly is key to limiting heart damage. 

Knowing the signs of a heart attack and the differences in symptoms between men and women can save a life.

Typical signs of heart attack may include:

• Uncomfortable pressure, tightness or pain in the center of the chest, lasting longer than a few minutes
• Pain or discomfort in one or both arms, back, neck, jaw or stomach
• Shortness of breath
• Breaking out in a cold sweat, nausea or lightheadedness 

However, not all heart attacks begin with sudden, crushing chest pain. Heart attacks, especially in women, can surface more subtly. And it’s important to note that about one-third of the patients who have heart attacks experience no chest pain. 

According to interventional cardiologist William Combs, MD, with LVH Cardiology–1250 Cedar Crest and Director of Interventional Cardiology at Lehigh Valley Heart and Vascular Institute, the most common symptom of a heart attack for both men and women is chest pain or discomfort. However, women can experience heart attacks without pressure in their chest.

Signs of heart attack in a woman also may include:

• Sharp pain, sometimes in upper abdomen
• Shortness of breath
• Nausea
• Vomiting
• Fainting
• Upper back pressure
• Extreme fatigue 
• Back or jaw pain

“With women, the symptoms are often much different. The pain is more often described as sharp and stabbing and doesn't usually travel down the arm the way it does with a man. It sometimes is in the upper abdomen. Sometimes it's on the right side of the chest. Women may think that it's acid indigestion or heartburn, or they think that their symptoms are related to something like that, because it's been sort of a myth that women don't get heart disease as often as men,” he explains.

Sundlof agrees that women are more likely than men are to experience atypical heart attack symptoms. “That’s why I always tell women, if you have any discomfort between the nose and navel, get it checked out.” 

How age plays a role

Age also is a factor for the differences between men and women and when they may first suffer a heart attack. “Women are more likely to have their first heart attack around age 72, while men are more likely to be around the age of 65,” Sundlof explains.

She adds that within five years of having a heart attack, women are more likely to have complications from a heart attack compared to men, so they're more likely to develop congestive heart failure, or suffer a stroke, compared to a man of the same age.

Unique risk factors for women

If a woman goes through pregnancy and develops high blood pressure or gestational diabetes, they are more likely to have cardiovascular disease prematurely. Their babies also are at greater risk for developing heart disease earlier than those whose mothers did not have those diagnoses during pregnancy. 

“We have a chance in our Women's Heart Program to affect two generations. If we can help women live healthier throughout all stages of their life, including adolescence and childbearing years, then they're less likely to develop those risk factors that are unique to women,” Sundlof says.

Another risk factor that's unique to women can occur as a result of breast cancer treatment. According to Sundlof, there are certain chemotherapeutic treatments that can have a detrimental effect on the heart. She notes that patients with inflammatory diseases such as lupus or rheumatoid arthritis also are at greater risk for developing heart disease.

“It's very important as a cardiologist that I don't work in a silo, and that I know what other diseases patients are being treated for.” That’s why Sundlof and her team at Lehigh Valley Heart and Vascular Institute work collaboratively so they can be aware of each patient’s individual health history.

She believes the strongest tool to heart attack prevention is education. “It's very important for women to know what their traditional as well as non-traditional risk factors may be,” she says. “Women tend to be the medical CEOs of the family – for their spouses, their parents and for their children. And so, if they know what heart health looks like, they're more likely to lead their family in a healthier direction.” 

Time is of the essence

Unfortunately, women often delay coming into the hospital when experiencing symptoms. “We know that women wait approximately 54 hours before seeking medical attention, whereas men wait about 16 hours. Women also are much more likely to disregard their symptoms. They’ll say, ‘I'm anxious’, or ‘I've had a lot on my plate’, or ‘I'm worried about a lot of things.’ Women tend to try to minimize what they're feeling and what they think is going on,” Sundlof says. 

One of the most important things Combs wants both men and women to understand is that if your symptoms are out of the ordinary, and especially if they are persistent for more than 15 minutes – or if you are experiencing any discomfort in the chest area, you should seek medical treatment as quickly as possible. “The sooner you can get a diagnosis, the earlier it's treated, the better the outcome. Some of the worst cases are women who will sit at home and suffer for 12 to 24 hours, or even days. And then they'll end up with severe heart failure and get really sick,” he says.

If you think that you know someone is having a heart attack or stroke, call 911.

Although your first reaction may be to drive a patient with symptoms of a heart attack or stroke to the hospital yourself, it’s best to call 911 first. Emergency medical services (EMS) personnel are able to provide treatment on the way to the hospital and are trained to revive a person if he or she is experiencing heart failure. Their reaction time can help a patient up to an hour sooner than being driven to the hospital. Do not wait more than five minutes after noticing these symptoms to make the call.

Even if you’re not sure if someone is experiencing a heart attack, it’s always best to take the necessary precautions. Minutes matter when it comes to a heart emergency, so it is important to act fast.