You probably already know your diet and activity level can influence your heart health, but did you know your gender plays a role as well? While cardiovascular disease is the leading cause of death for men and women in America, both sexes experience this in vastly different ways. These disparities are mostly due to biology, and each gender requires specialized care to address them properly. As researchers study this topic, they’re creating more accurate diagnostic and treatment methods to help all people live healthier lives.
How Gender Affects Your Risk of Heart Disease
One of the main female sex hormones, estrogen, is present throughout a woman’s life. However, as menopause approaches, levels of this chemical begin to drop. Researchers have found that naturally occurring estrogen relaxes the walls of arteries, allowing blood to pass through them more easily. Once women experience a decline, they lose the extra flexibility and experience a higher risk of heart disease and other cardiovascular events.
“After [menopause], women and men had similar outcomes with [heart disease],” said Dr. Stephanie Coulter, cardiologist at Baylor St. Luke’s Medical Center and Director of the Center for Women’s Heart and Vascular Health at Texas Heart Institute. “Women outlive men, but they catch up and end up with a slightly higher risk of dying of heart disease just because they live longer. Burden of heart disease accumulates over time.”
Additionally, certain conditions that affect only women are risk factors for heart disease. Polycystic ovary syndrome (PCOS), endometriosis, gestational diabetes, and preeclampsia are associated with an increased likelihood of adverse cardiac events. In fact, preeclampsia doubles the risk of heart disease and clotting issues five to fifteen years after pregnancy.
How Heart Attacks Differ for Men and Women
According to the American Heart Association, the average age at which a man experiences his first heart attack is about 65 while the average age for women is 72. Researchers believe that this discrepancy is due to the protective factor of naturally occurring estrogen. While women tend to experience heart attacks later in life, theirs tend to be more severe and are more likely to result in a second heart attack within two years. Women also tend to have less obvious symptoms of heart attacks, which can lead to delayed treatment. In fact, the median delay to go to the ER for a heart attack is about 54 hours for women and 16 hours for men.
Furthermore, within five years of a heart attack, 47% of women will pass away or develop complications compared to 36% of men. Researchers attribute this discrepancy to two phenomenons, which currently don’t have an understood reason: women are less likely to get the tools they need to improve their health after a heart attack, and women are less likely to take their medication consistently. Choosing a provider that understands these differences is important for receiving individualized care.
How Gender Affects Heart Failure
About half of Americans with heart failure are women, yet women are significantly underrepresented in heart failure clinical trials. This creates obstacles in determining clear conclusions regarding disparities between the sexes. However, experts do have an idea of these differences.
Starting at the onset of menopause, women tend to experience elevated blood pressure and increased LDL cholesterol, glucose, and triglyceride levels. All of these factors can weaken the heart, resulting in the inefficient output of blood that is characteristic of heart failure. Women often display more symptom burden with this condition, and providers may initially mistake it for a respiratory issue. While women are more likely than men to develop heart failure after a heart attack, the most common cause of heart failure in men is tissue damage after a heart attack.
No matter your sex, it’s essential to stay on top of your heart health. Schedule an appointment with your primary care physician to get an assessment of your current health and risk factors. For comprehensive cardiovascular care, find a St. Luke’s Health cardiologist near you.
TMC News | Cardiologist Stephanie Coulter, M.D.
American Heart Association | Menopause and Heart Disease
VeryWell Health | Heart Disease: Men vs. Women
Texas Heart Institute | Women and Heart Disease
Texas Heart Institute | A Change of Heart at Menopause
NCBI | Gender differences in coronary heart disease
American Heart Association | Heart Disease and Stroke Statistics-2019 At-a-Glance
Harvard Health Publishing | The heart attack gender gap
Wiley Online Library | Sex differences in heart failure