Same Disease, Different Risks & Symptoms: Cardiovascular Disease in Women
Authors: Nabilah Gulamhusein: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Elaha Niazi: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Smriti Juriasingani: Cumming School of Medicine, University of Calgary
Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).
Cardiovascular disease is the leading cause of death among women worldwide, and in fact, women are more likely to die from a heart attack than men. This often surprises women and their care providers because cardiovascular disease has traditionally been considered a male-dominated disease. Deaths due to cardiovascular disease have declined in the last 50 years in men, but have risen in women, especially in younger women. It is increasingly apparent that there are both sex-based (related to biological attributes) and gender-based (related to socially constructed identities, expression, roles, and behaviors) differences in cardiovascular risk factors, as well as the development and progression of cardiovascular diseases. Though we have made great gains in improving men’s heart health, women remain under-researched, under-diagnosed, under-treated, and under-supported; consequently, many women are unaware of their cardiovascular disease risk.
Though many consider cardiovascular disease only a disease of older women, it affects women at all life stages. Reproductive-aged women have been developing increasingly disadvantageous cardiovascular disease risk profiles, including obesity, physical inactivity, an unhealthy diet, and stress; these factors appear to have a larger impact on women than men. While these are certainly important considerations in cardiovascular disease risk for young women, it is time to adopt a broader understanding of female-specific risk factors.
In addition to traditional risk factors, female-specific and female-predominant factors contribute to cardiovascular risk. Conditions related to fertility, such as polycystic ovarian syndrome and menstrual irregularities, have been associated with an increased cardiovascular disease risk. In addition, certain pregnancy complications can increase heart disease risk, including gestational hypertension and diabetes. It is critical that women have the opportunity for informed discussions with healthcare providers to mitigate reproductive and pregnancy-related risks. There is also a multitude of medical conditions disproportionately impacting women that result in increased cardiovascular risk. These include depression, diabetes, hypertension, autoimmune diseases, and chronic kidney disease. Awareness of these important female-specific and female-predominant risk factors can empower women in making heart-healthy choices.
There is no question, however, that as a woman ages, cardiovascular risk increases considerably due to changes in the heart and blood vessels. The timing of the onset of menopause, as well as perimenopause (when the transition to menopause begins, but before a final menstrual period), may influence a woman’s cardiovascular risk. Premature menopause (before age 40) and early menopause (before age 45) are significantly associated with increased cardiovascular risk. Additionally, cardiovascular disease risk commonly increases after menopause, which is attributed to changes in hormone levels (e.g., estrogens).
Early heart attack symptoms are missed in more than 50% of women and therefore, it is important to recognize that women may have different symptoms compared to men during a heart attack. While women experience symptoms such as sharp chest pain, they may also have aching sensations across the back and stomach, pain in the jaw, neck or arm, shortness of breath, abnormally excessive sweating, nausea, indigestion, and extreme fatigue. Unlike men, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. Being informed and spreading the word about heart disease symptoms in women is the first step towards protecting the women in our lives.
Knowing that women have unique cardiovascular risk factors and subtle symptoms can be overwhelming, however, heart disease is largely preventable. First, following Canada’s 24-hour movement guidelines, including getting 150 minutes of moderate to vigorous physical activity per week, reducing sedentary time, and getting enough good quality sleep is recommended for a healthy lifestyle. Research shows that consuming 7–10 servings of fruits and vegetables every day, while limiting processed foods, sugar and salt are key ways to reduce cardiovascular risk. It is also important for women to have regular check-ups with their healthcare providers and take their medications as prescribed. Finally, living free from commercial tobacco and vaping while reducing alcohol intake and actively managing stress can also be beneficial.
To learn about women’s cardiovascular health, including risk factors, symptoms, treatment, and support, you can participate in Wear Red Canada or visit WearRedCanada.ca! Wear Red Canada is run by volunteers across the country, including healthcare providers, scientists, and people with lived experience. Wear Red Canada Day is celebrated annually on February 13th to raise awareness about women’s heart and vascular health. Each year, you are invited to attend presentations by leading experts, join the Wear Red Canada Movement Challenge, and visit local landmarks that will light up RED in support of women’s heart health. On February 13, wear RED and join us on social media to share selfies or pictures of your participation in these events with the hashtag #HerHeartMatters and tag @WearRedCanada to share this important message. By starting conversations about women’s cardiovascular health and getting informed, we can increase awareness and improve the health of the women in our lives.