As women, we are twice as likely to die of heart disease as of breast cancer. Yet we get annual mammograms faithfully but we rarely get heart check-ups or do preventative maintenance for heart health. This is due in part to the misperception that woman do not get heart disease, especially before menopause. The hormone estrogen protects a woman’s heart and blood vessels, improves her cholesterol levels, and therefore delays the development of heart disease. Heart disease typically occurs in women 10 years after it occurs in men. But when it strikes, it is likely to be more deadly.
When it comes to heart disease, women differ from men in several other ways. Risk factors for heart disease are similar among the sexes but have different relative importance. Diabetes and smoking play a bigger role for women while cholesterol levels affect heart disease risk in men. The effects of genetics and hypertension (high blood pressure) are similar in both sexes.
Women also have different symptoms. They tend to be older than men when they present. Symptoms are vague and can include fatigue or breathlessness rather than the classic symptom of chest pressure, sometimes described as an “elephant on my chest.” That is why it is not unusual for women to be misdiagnosed or underdiagnosed.
Diagnostic testing is different for woman as well. Routine ECG (electrocardiogram) stress testing, where a patient’s heart is monitored during exercise on a treadmill, is less effective in women because of our lower exercise capacity and non-specific changes in our ECG. Pairing stress testing with heart imaging is a more accurate diagnostic tool for women who are suspected of having heart disease.
So do some preventive maintenance for your heart. Have your blood pressure, cholesterol and blood sugar checked. Work toward a healthy body weight, refrain from smoking, and exercise aerobically for at least 20 minutes three times per week. Most importantly, listen to your heart. If you have heart disease risk factors or feel breathless, are unusually fatigued, or have symptoms when you are physically active, get evaluated.