Even modern research, both in America and around the world, indicates that women are still treated differently for cardiovascular problems than men. When they have high cholesterol, they are less likely to be prescribed statins, which significantly reduce the risk of heart attacks and strokes. They are also less likely than men to be prescribed blood thinners to prevent clots in the treatment of atrial fibrillation. A British report covering the years 2003-2013 shows that 8,000 more people in England and Wales could have been saved during this period if they had been treated the same as men who had a heart attack. In women with a heart attack or advanced coronary artery disease, the risk was 34%. Procedures—bypass grafts and stents—were used less often. What’s more, emergency responders and doctors sometimes still downplay the symptoms of a heart attack, and women seek help later.
– In the 1980s and early 1990s, prevention of cardiovascular diseases was mainly aimed at men, admits Prof. Janina Stępińska, cardiologist, director of the National Institute of Cardiology, founder of the Intensive Cardiology Clinic. – Even most illustrations of heart attacks tended to depict a man. All preventive efforts were directed at them and after some time they brought results. Prevention aimed at women started much later and fortunately, albeit slowly, is yielding results.
We now know that heart disease, heart attacks and strokes also affect women. European research shows that we are more likely to die from them: 55 percent women versus 43 percent men. But there is also good news: we can prevent most cardiovascular problems through prevention, education and the introduction of a healthy lifestyle.
Estrogens have a beneficial effect on the heart, including: they increase the concentration of good HDL cholesterol
When security passes
The causes of cardiovascular disease risk are similar in women and men, and the differences lie in the fact that they occur at different stages of life. Heart disease usually affects women 10 years later than men. This is because until menopause occurs, our health is protected by estrogen. These female hormones have a beneficial effect on the heart, including: increasing the concentration of good HDL cholesterol, which is important in combating atherosclerotic plaques that block blood vessels. Scientists also emphasize that estrogens modulate gene expression. Women before menopause are less likely to have problems with the cardiovascular system and ischemic heart disease. However, during perimenopause the risk increases and, in the postmenopausal period, women get sick as often as men. Their health is at greater risk because they may have many more comorbidities: diabetes, hypertension, hypercholesterolemia.
A woman’s heart is slightly smaller than a man’s. Its capacity is 10 to 15 percent smaller than that of a man’s heart. It also differs in the caliber of the coronary vessels that supply blood to the heart muscle. The coronary vessels have thinner walls, are narrower and more tortuous, making women more vulnerable to certain cardiovascular diseases. This structure of the vessels also complicates the surgical treatment of coronary artery disease, i.e. so-called bypass surgery, vessel dilation and stenting. – Women’s hearts also beat a little faster, but these differences are not statistically significant – emphasizes Prof. Stępińska. – An adult’s heart beats 60-80 times per minute at rest. During exercise, the heart rate increases. The cause of a faster heartbeat can be emotion, but also, for example, anemia or hyperthyroidism. Women are more prone to so-called supraventricular extrasystoles, which are usually a mild arrhythmia.
Time is important
Heart attacks in women can be much more dangerous than in men due to the older age at which they occur. It is also dangerous that a heart attack in women occurs without typical symptoms. – It often starts slightly differently than in men, with back pain, neck pain or pain in the upper abdomen, fainting, nausea and vomiting. Sometimes the first symptoms are shortness of breath, palpitations, dizziness – says Prof. Stępińska. – There is also classic coronary pain, located behind the sternum, radiating to the jaw, shoulders, hands (not necessarily to the left), accompanied by a feeling of anxiety and sweating.
The myth that women are at lower risk of heart attacks led them to believe this, which is why they only called an ambulance long after the symptoms appeared. – At one of the American Heart Association conferences I attended, a short film was shown in which the main character was a young woman, a wife, a mother. When she felt chest pain, before calling an ambulance, she prepared breakfast for the whole family and took the children to school. She did her duty and neither she nor her husband thought it was a heart attack. Finally, emergency services were called, but there was a sudden cardiac arrest due to potentially fatal cardiac arrhythmias – says Prof. Stępińska.
Even doctors often believed that women’s problems could be caused by menopause or menopause. – It happened that a woman came to the emergency room and first they checked whether it was neurosis or some dissatisfaction with life. When this was ruled out, only then the patient underwent interventional treatment – says Prof. Stępińska. And in ischemic disease, time is important. The longer the pain that is a symptom of ischemia lasts, the larger the area of muscle necrosis will be, which translates into lower performance after the infarction.
There is also evidence that women are treated in a less modern way than men. They are treated pharmacologically much more often, and men are referred much more often for ablation, a modern interventional treatment. This includes coronary heart disease and atrial fibrillation.
Broken heart
Takotsubo syndrome is a condition that occurs much more frequently in women than in men and can mimic a heart attack. The name comes from a vessel used to catch octopuses, which has a characteristic shape: a narrow neck and a wide, flat bottom. Takotsubo syndrome is also called ruptured heart disease or stress cardiomyopathy, because the pain is associated with a lot of stress and emotions, not necessarily bad ones. An electrocardiogram or blood tests cannot detect this condition. Only imaging tests that show the characteristic shape of the left ventricle and the absence of changes in the coronary arteries allow the diagnosis.
