Risk factors and symptoms of CVD can be different for women. Estrogen plays an important role in risk for CVD. Besides chest pain, women may have subtle symptoms such as heartburn, nausea, milder discomfort in the chest, back and abdomen or a sensation of generalized weakness.
**Nerds, for the purpose of this article, “women” refers to people born with a uterus and ovaries (female sex assigned at birth) and “men” refers to people born without (male sex assigned at birth). Those Nerdy Girls strive to use inclusive language. This time we’re referring to some biological differences that relate to estrogen because this is how it has been studied.
Cardiovascular disease (CVD) is the leading cause of death globally for both men and women. However, risk factors and symptoms vary for men and women. Understanding the most common symptoms can improve prevention and treatment.
CVD has historically been considered a male disease. Men have a slightly higher risk of coronary artery diseases than women, but this gap shrinks with age. The assumption that CVD is a male disease has negatively affected diagnosis and treatment for women. Clinical studies often included only male subjects, leaving women out entirely. Women can present with subtle symptoms which aren’t recognized as easily. Diagnostic testing for women can be less accurate. For example, cardiac stress tests that use an EKG to check for blood flow changes to the heart during peak exercise can be affected by sex differences in exercise capacity. As a result, CVD may be discovered later or at a more serious stage, when there is less effective treatment available and outcomes are worse.
Differences in risk factors. for women and men:
General risk factors for CVD include high blood pressure, diabetes, high cholesterol, smoking, being overweight, heavy alcohol use, being sedentary, eating a diet high in saturated fats and processed foods, increasing age, and family history of heart disease.
Women develop CVD on average 5-10 years later than men, usually after the age of 55. Risk increases significantly after menopause, when estrogen levels reduce. This is true in both natural menopause where estrogen production drops with aging or if menopause is caused by a hysterectomy with oophorectomy (removal of the uterus and ovaries). Scientists have observed that higher levels of estrogen might be beneficial in multiple ways, such as increasing development of new blood vessels (called “angiogenesis”) and relaxation of the blood vessels (called “vasodilation”) to improve blood flow. This reduces hardening of the blood vessels (called “fibrosis”), reducing the risk of CVD. However, it’s likely more complex in the human body, because simply supplying estrogen replacement therapy to postmenopausal women does not significantly reduce cardiovascular risk. Other factors might play a role in postmenopausal women’s increased risk for CVD, including greater incidence of diabetes, high blood pressure and cholesterol and more abdominal fat, which all raise the risk of CVD. Besides menopause, women with a history of preeclampsia or gestational diabetes during pregnancy are at increased risk for CVD.
Symptoms of CVD in women vs. men:
The most classic symptom of CVD is angina, or chest pain occurring with physical exertion that can radiate to the neck, shoulder, back or jaw. This is often associated with difficulty breathing, dizziness, and sweating. If angina occurs at rest, it can be a sign of more advanced disease. Both men and women can experience these typical symptoms. Women are more likely to have other subtle symptoms, such as heartburn, nausea, milder discomfort in the chest, back and abdomen or a sensation of generalized weakness like when you have the flu. Not recognizing these symptoms can delay appropriate testing, diagnosis and treatment for women. If you have symptoms that you are concerned about, schedule an appointment with your healthcare provider.
Recognizing that there are differences in risk factors and symptoms of CVD in women is important. Educating ourselves on these differences can help us to reduce cardiovascular risk and work towards better heart health this February and beyond!
Stay Safe. Stay well.
Those Nerdy Girls
CVD in Women: Understanding Symptoms and Risk Factors
The protective role of estrogen in CVD
CVD and the Female Disadvantage