World Heart Day 2023: What is the difference between heart disease risks and symptoms of men and women?

If we say heart disease; for both women and men, coronary heart disease is the largest contributor to cardiovascular disease (CVD) morbidity and mortality. It can develop and present in dramatically different ways across both sexes because of:

To observe World Heart Day 2023, Dr. Ramji Mehrotra, Chief - CTVS, Cardiac Sciences, Cardiac Surgery (CTVS), Robotic Surgery, BLK-Max Super Speciality Hospital has explained the differences in the anatomy of the cardiovascular system.

Compared to men, women have smaller hearts and narrower blood vessels. The female heart has a larger ejection fraction and beats at a faster rate but generates a smaller stroke value (blood volume sent to the body with each heartbeat).

The difference in the site of development of Cholesterol plaque 

Men typically develop this plaque buildup in the largest arteries that supply blood to the heart. Women are more likely to develop this buildup in the heart’s smallest blood vessels, known as the microvasculature.

The following bad behaviours contribute to cardiovascular health

• Smoking                                     - 
• Physical activity                              
• Sleep

Apart from the above bad behaviours, the following health factors add to cardiovascular health 

• Cholesterol  
• Blood pressure
• Diet and weight 
• Glucose control                             

Besides traditional risk factors, there are sex differences in the prevalence and effect of cardiovascular risk factors

Male-related risk factors:

Decrease in level of testosterone (cardioprotective) with age. 

Female-related risk factors:

• Low high-density lipoprotein cholesterol as compared to men.
• Women with diabetes have a 2-to-4-fold greater risk for CVD compared to men.  
• Some autoimmune conditions, such as systemic lupus erythematosus and rheumatoid arthritis, which are more common in women than men, present an increased risk of CVD due to chronic inflammation. 
• Pregnancy-related conditions - multiparity and lactation can be associated with insulin resistance and dyslipidemia. 
• Pregnancy-related disorders - women who give birth prematurely, have recurrent pregnancy losses or deliver small-for-gestation age babies, hypertensive disorders of pregnancy, gestational diabetes and peripartum cardiomyopathy may be at higher risk for future cardiovascular events.
• Polycystic ovary syndrome has a higher risk of CVD due to insulin resistance, and metabolic syndrome. 
• Premature menopause (Low levels of estrogen) is associated with autonomic dysfunction, central adiposity, insulin resistance, and dyslipidemia leading to an increased risk of CAD, Heart Failure, Atrial fibrillation, and Ischemic stroke.

A common factor, stress and depression, affects women’s hearts more than men’s and both may trigger heart attack symptoms. In particular, a condition known as “broken heart syndrome” or stress cardiomyopathy, can be brought on by stressful situations and cause severe, but usually temporary, heart muscle failure. This condition occurs most commonly in women after menopause.

All these risk factors mentioned above may influence the risk of coronary artery disease, valvular heart disease, arrhythmia, heart failure and ischemic stroke in the development of pathophysiology with sex differences.

Symptoms of Heart diseases in men and women:

Men and women share many of the same symptoms for heart disease and heart attacks.

However, men are more likely to experience well-known heart attack symptoms such as:

• Crushing chest pain
• Squeezing, discomfort, or fullness in the chest
• Pain in the arm, jaw, or back
• Shortness of breath
• Cold sweat
• Nausea

Women are less likely to experience crushing chest pain. They have a higher chance of having the following symptoms instead:

• Pain in the jaw, neck, or chest
• Feeling faint or lightheaded
• Squeezing on the upper back
• Fullness, pressure, or squeezing in the centre of the chest

As a result, women are more likely to ignore their cardiac symptoms as it is less obvious that they relate specifically to the heart. Also, women are less likely to complain about their problems for fear of disrupting the family members' comfort and many times they report late. This also increases their risk of sudden fatal cardiovascular events. But not everyone with heart disease has all (or even most of) these symptoms, especially not all women. Therefore, it is very important to mitigate risk factors, have healthy habits, get regular check-ups and should not ignore vague symptoms. 

What do we mean when we say heart disease?

Identify the risk factors and the symptoms associated with heart disease as early as possible, go to the doctor, get checked and follow up. “The Good News is that 90% of heart disease cases can be prevented with healthier lifestyle choices."

ALSO READ: World Heart Day 2023: Know how  heart-healthy diet is the cornerstone of prevention