THE CARDIOVASCULAR INSTITUTE

WOMEN'S CARDIOVASCULAR HEALTH

We have created this special section of our website to address cardiovascular disease in women. Heart disease is the leading cause of death among women, killing six times more women than breast cancer. Symptoms of a heart attack in women can be quite different than in men. We hope that by providing this information to our patients we can help to increase awareness about cardiovascular disease in women and ultimately save lives.

Did you know?

Women are more likely than men to have a heart attack without chest pain

• Findings from the Women’s Health Study show that daily aspirin does not prevent first heart attacks in healthy women as it does in men
• Smoking may increase a woman’s risk of heart disease more so than a man’s because it lowers levels of the female hormone estrogen
• Unlike men with heart disease, some women – particularly younger women – who have a heart attack do not have high levels of fatty plaque clogging their arteries

• Women who have gone through menopause are 2 to 3 times as likely to have heart disease as premenopausal women of the same age

How big a problem is heart disease in women?

• 435,000 American women have heart attacks each year; 83,000 are under age 65 and 9,000 are under age 45. Their average age is 70.4.
• Heart disease is the leading cause of death of American women and kills 32% of them.

• 267,000 women die each year from heart attacks, which kill six times as many women as breast cancer

How does heart disease compare between men and women?

• 38% of women and 25% of men will die within one year of a first recognized heart attack.

• 35% of women and 18% of men heart attack survivors will have another heart attack within six years
• Women are almost twice as likely as men to die after bypass surgery

Statistics complied from:
National Center on Health Statistics; National Heart, Lung and Blood Institute; and American Heart Association's 2002 Heart and Stroke Statistical Update, which may be viewed online at: http://www.americanheart.org/downloadable/heart/10148328094661013190990123HS_State_02.pdf.

How do heart disease symptoms differ in men vs. women?

Women may experience early symptoms of cardiovascular disease differently than men. The symptoms in women can be far subtler. If you or any woman you know shows these signs, seek medical attention right away.

• Shortness of breath, often without chest pain of any kind
• Flu-like symptoms — specifically nausea, clamminess or cold sweats
• Unexplained fatigue, weakness or dizziness
• Pain in the chest, upper back, shoulders, neck, or jaw
• Feelings of anxiety, loss of appetite, discomfort

In fact, women are less likely than men to feel chest pain during a heart attack. Studies suggest that more women than men experience so-called "atypical" symptoms, such as back pain, nausea, or fatigue. And for many people, a heart attack won’t strike without warning. A study of 515 women who had a heart attack found that 95% experienced symptoms before the attack. For this reason, it is important for women to recognize the various signs and symptoms of a heart attack so that they can take immediate action if the need arises. Even if you have already suffered a heart attack, the symptoms of a second attack may not be the same as your first. In addition women may experience whjat are referred to as pre-heart attack symptoms.

What are pre-heart attack symptoms?

Pre-heart attack or prodromal symptoms are symptoms that occur before a heart attack, generally from about 4 to 6 months to 1 week before (though some people report these symptoms up to 2 years before their heart attack).
Common pre-heart attack symptoms include:5

• Unusual fatigue
• Sleep disturbance
• Shortness of breath
• Chest pain
• Indigestion
• Anxiety
• Pain in shoulder blade or upper back

Shortness of breath seems to be a particularly important symptom for men and women, though it is often not thought of as a serious medical concern. In a study of nearly 18,000 men and women (40% were women), those who experienced shortness of breath were 3 to 5 times more likely to die from heart disease than those who did not have this symptom. This symptom seemed to be a particularly good indicator of heart troubles for people who were not previously aware that they had heart disease.

Do women and men experience pain differently?

Some studies have shown that men and women perceive pain differently and this may help explain why men and women report different heart attack symptoms. Women have a lower threshold for pain, including pressure-type pain, than men. Several studies have found that when women experience chest pain, they rate it as more severe than men. Women may appear more likely to experience so-called atypical symptoms because they report a wider variety of symptoms and because they experience these symptoms more intensely than men.

In Summary

• Women are less likely to experience chest pain during a heart attack than men
• Women are more prone to experience so-called "atypical" symptoms such as nausea, indigestion, or fatigue before and during a heart attack
• In women, many prodromal (pre-heart attack) symptoms are the same as "atypical" symptoms at the time of a heart attack
• Recognizing heart attack symptoms and getting help early can prevent lasting heart damage due to a heart attack