How is heart disease different in women?

  • Chest pain is often the first symptom which will alert you to problems with your heart. But women and their doctors often misinterpret this symptom. Women are far more likely to land up with a diagnosis of heartburn or gastro-oesophageal reflux disease (link to A-Z article), or even stress or depression. In men, the presence of chest pain will accurately predict CAD more than 90% of the time. In women, however, this predictive value falls to around 70%.
  • The risk factors for CAD are similar in women, but there are differences. The ways in which cigarette smoking, hypertension, diabetes, family history and obesity affect women are subtly different from the ways in which they affect men.
    • Cigarette smoking – possibly the most important risk factor for CAD – has declined in men, but increased in young women. Smoking as few as one to four cigarettes a day seems to increase the risk of death from CAD in women.
    • Lipid levels are generally lower in women than in men between the ages of 20 to 55. But after the age of 55, women’s cholesterol levels rapidly rise and may be higher than those of men of the same age. The levels of HDL cholesterol (the good form of cholesterol) are higher in women than in men until after the menopause (link to A-Z article). After menopause, increased total cholesterol, decreased HDL cholesterol and triglycerides are as important as risk factors for CAD as they are in men.
    • After the age of fifty, women are twice as likely to suffer from high blood pressure as men of the same age. Because women live longer than men, there are many more hypertensive women than men. In spite of this, all major studies of the effects of hypertension on CAD have been carried out on men. There is no reason to believe that hypertension is not a risk factor for CAD in women, so look after you blood pressure!
  • Diabetic women are more likely to develop CAD than men with diabetes. This is probably because diabetes is associated with high blood pressure, obesity and high blood lipids which are more common in elderly women than in men.
  • Family history is a particularly important factor in women – more so than in men. This is particularly the case in young women.
  • Obesity is a difficult risk factor to evaluate in women – other than the fact that it predisposes to type 2 diabetes. Women tend to accumulate fat on their hips and thighs, where it doesn’t carry the same risks as the abdominal accumulation of fat which is more common in men. However, after the menopause, women often experience a shift in fat distribution, with more landing up around the tummy. This may lead to a higher risk of CAD. No studies have been done, however.

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