From Heart Attack to Heart Failure: What Doctors Miss in Women

Janet Tiberian Author
By Janet Tiberian, MA, MPH, CHES
February 10, 2020
Women and Heart Disease

Many people associate heart disease with men. But heart disease is also a woman’s disease. In fact, more women die from heart attacks each year than men. Heart disease is the leading cause of death among American women.

You might be thinking – what about breast cancer? Surprisingly, heart disease claims the lives of 300,000 women each year compared to 40,000 lives from breast cancer.

Why is cardiovascular disease so pernicious for women? One factor is heart attack. Women don’t always recognize when they’re having one. Plus, doctors miss the signs of a heart attack in women 53 percent of the time. Stroke is also a big challenge for women. High blood pressure is a main risk factor for stroke, but one in three women with high blood pressure don’t know they have it, according to the Centers for Disease Control and Prevention. 

And then there’s heart failure — about half the women with heart failure get the wrong treatment, according to researchers at the University of Bergen (Norway). Why? Because healthcare workers miss the symptoms and risk factors of heart disease that are unique to women.

“The medical community is working hard to improve cardiovascular care for women,” says Bernard Kaminetsky, MD, medical director, MDVIP. “Researchers are still learning the differences between the genders as to what causes cardiovascular disease. A better understanding will help close the gap in the treatment in conditions like heart failure.”  

Heart Failure

Heart failure is a term used to describe a weakened heart that’s not pumping enough blood throughout the body efficiently. Since cells need oxygen- and nutrient-rich blood to function properly and maintain healthy organs, heart failure can be fatal.

To understand how heart failure is undertreated in women, consider the two main causes of the disease: 
untreated hypertension and heart attack.

Risk Factors for Heart Disease in Women

Some common risk factors for heart disease in women include:

  • High blood pressure: It damages the inner lining of arteries, making it easier for bad cholesterol particles to enter the lining and accumulate along the arterial wall. As a result, arteries stiffen and narrow, causing the heart to work harder to pump blood throughout the body. Over time, the increased workload results in a thickened, enlarged heart that pumps blood less efficiently. 
  • Estrogen: In younger women, estrogen keeps arteries flexible, enhancing blood flow. Unfortunately, after menopause, the cardiovascular protective effects of estrogen wane along with the hormone. This raises the risk for connective tissue to form, which can stiffen arteries and raise blood pressure.
  • Obesity: As women age— especially during and after menopause—it also becomes increasingly difficult to manage weight. Older women are more likely to be obese than men according to the U.S. Centers for Disease Control and Prevention, and obesity is a major risk factor for heart disease and all its complications, including heart failure. 
  • Smoking: One other factor that impacts women differently than men: It’s tougher for women to quit smoking, according to a review published in Preventive Medicine. Smoking can lead to high blood pressure and coronary artery disease— two major risk factors for heart failure. 

The Bottom Line

“Heart disease and heart failure risk manifests differently in women than in men. That’s why it’s important to see your primary care physician regularly and discuss your risk factors for heart disease,” Kaminetsky says.  

If you don’t have a doctor, consider partnering with an MDVIP-affiliated physician. MDVIP doctors have the time to work with you to help you develop a personalized wellness program and help reduce your cardiovascular disease risk factors. Find a physician near you and begin your partnership in health » 

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About the Author
Janet Tiberian Author
Janet Tiberian, MA, MPH, CHES

Janet Tiberian is MDVIP's health educator. She has more than 25 years experience in chronic disease prevention and therapeutic exercise.

View All Posts By Janet Tiberian, MA, MPH, CHES
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