Heart disease different in women, but still just as deadly – Ahwatukee Foothills News

One interesting difference between men and women involves the cardiovascular system and the development of heart disease and subsequent symptoms.

There is growing awareness that when a woman experiences symptoms of heart disease, these symptoms may differ from what is universally recognized as typical cardiac symptoms. This is because of the differences in the male and female cardiac physiology.

Heart disease in men generally involves the larger blood vessels supplying heart muscle whereas in women, heart disease often involves the smaller vessels.

For men, when the larger vessels become narrowed because of atherosclerosis (so called hardening of the arteries) and plaques of fatty deposits, blood flow to heart muscle decreases. This causes the crushing pressure-type of chest pain known as angina.

On the other hand, in the female heart, the smaller vessels become blocked before the larger ones. So a womans angina is more likely to be vague and expressed as fatigue, nausea, and/or dizziness. A womans description of heart pain can frequently be less dramatic and therefore draw less attention and less urgency.

When women seek care, their providers may be misled by the presenting symptoms and a diagnosis of heart disease may be missed. In fact a large proportion of women who have a first heart attack state they never had any typical warning symptoms.

Even though heart disease is the number one cause of death in our society, the average life span of a woman still exceeds that of a man. This is assumed to be because of the female sex hormone, estrogen. It is theorized that estrogen serves a protective function for a woman during her reproductive years.

This theory was the basis for the recommendation that women continue the hearts exposure to this hormone during menopause by way of prescribed hormone replacement therapy.

Besides helping a woman to deal with menopausal symptoms, hormone replacement therapy was assumed to offer secondary gains of continued protection against the development of heart disease.

The cardio-protective benefits of hormone replacement therapy are believed to diminish after approximately five years. This poses a dilemma for women as we cannot allow the atherosclerotic effects of increased LDL levels to go un-checked either.

Menopausal women whose LDL levels have risen over the years without being addressed are at risk for developing heart disease on a par with age-matched males. While these women seem to be catching up to men in the development of heart disease, they are not being discovered or treated at the same rates as men.

Women today, unlike previous generations, need to realize that they will have many more years to live without the protective effects of estrogen. Women need to be pro-active and make sure that a cardiac work-up is considered (including blood tests to asses LDL levels) if they experience vague symptoms that dont add up to another diagnosis.

The Framingham Risk Factor Analysis is an excellent tool for estimating the 10 year risk of heart attack in men but it falls short in accuracy for women.

A newer tool is the Reynolds Risk Score that includes parameters that increase accuracy for women. It is a simple questionnaire but it substantially improves the ability to predict cardiovascular risk in women, so much so that if used consistently, 20-25 percent more women at high risk for heart disease could be identified and offered preventive therapies.

The standard angiogram, the procedure that identifies the degree of narrowing in cardiac arteries, may not be a sufficient diagnostic tool for women. The Calcium Heart Scan may provide additional useful information as it identifies atherosclerosis in the smaller vessels.

Women must be encouraged to partake in standard heart disease therapies such as weight loss, exercise, dietary changes, stress management, and the use of appropriate medications. Just because a woman is menopausal and lacks estrogen, there is much she can do to prevent or even reverse the development of heart disease.

-Agnes Oblas, ANP-C, is a board-certified nurse practitioner in adult primary care with a private practice in Ahwatukee.

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Heart disease different in women, but still just as deadly - Ahwatukee Foothills News