While heart disease was considered a "man's disease" until the 1950s, relatively recent advances in cardiac research has shown that it afflicts women, as well. According to the American Heart Association's 2013 numbers, more than one in three female adults has some form of cardiovascular disease. And since 1984, the number of cardiovascular deaths for women has exceeded those for men.
High cholesterol, high blood pressure and obesity are common risk factors in both men and women, but others seem to have a greater impact on women's hearts. The Mayo Clinic lists those as metabolic syndrome, a combination of abdominal fat, high blood pressure, high blood sugar and high triglycerides; mental stress and depression; and smoking. Gestational diabetes during pregnancy and low levels of estrogen after menopause are female-specific risk factors, as well.
Another difference is that men between the ages of 45 and 80 years are at a higher risk, while in women the risk increases between 60 and 80 years, says Dr. Manish Mehta, an internal medicine specialist with Providence Health Group in Medford. And that's enough to affect the ways women are diagnosed and treated.
"The likelihood of misdiagnosing a heart attack in women [as indigestion, gall bladder disease or anxiety] is increased by the fact that women tend to have heart attacks later in life, when they often have other diseases, such as arthritis or diabetes, that can mask heart attack symptoms," the doctor explaines.
Even the way heart attacks "look" on men vs. women has been reported to be different. Men more often experience the dramatic crushing chest pain we most associate with heart attacks, Mehta says. But many women experience one or any combination of these conditions: pain under the breastbone or in the abdomen, indigestion, difficulty breathing, nausea or unexplained fatigue. Research by the Mayo Clinic has determined this may be because women tend to have blockages in the smaller arteries that supply blood to the heart, in addition to their main arteries.
(*Note: Heart attacks can manifest in many ways in both men and women. If in doubt, err on the side of caution and seek immediate medical help.)
Dr. Brian Gross, a cardiologist with Southern Oregon Cardiology, reports that the original research suggesting the differences in the way heart disease affects men vs. women is being challenged by newer evidence that shows they don't exist or are so small as to be insignificant.
"We are always trying to move forward with the best information we have at the time," he says. "But a new, more thorough and comprehensive study is saying, 'We can't seem to identify those differences; we may have to backtrack a bit.'"
More important than the why or how of heart disease in either gender is the treatment, he adds. And that is getting progressively more individualized.
"Twenty years from now, we'll have a lot more stuff, and a lot more focused stuff," Gross says, adding that cardiac health care eventually will be personalized beyond gender to race and individual family histories. "The greatest hope is that we will be able to personally identify what your risk profile is so we can cut down on the amount of unnecessary medications and surgery."