How much do you know about heart disease in women? Take our Quick Quiz!
Take a minute to read and answer True or False to each of the following statements:
Cardiovascular (heart) disease is the number one killer of women.
A woman can have a severe heart attack and not know it.
Symptoms of a heart attack can be different for women from men.
After a heart attack, a woman is more likely to die within a year than a man.
Older women with heart disease are more likely to develop dementia.
The correct answer for every question is True. If you didn’t get them all right, you’re not alone.
Heart disease is the leading cause of death for both women and men in the United States, but it’s often considered to be a “man’s disease,” so women can be under-diagnosed and under-treated.
Heart disease can mean several types of heart conditions. The most common is called coronary artery disease (CAD), which reduces blood flow to the heart because the blood vessels (arteries) that deliver oxygen to the heart become narrowed by plaque. Plaque is made of calcium, cholesterol, other fatty substances, and waste products. It builds up on the walls of the arteries and blocks blood flow, which means less oxygen can be delivered to the heart. Without oxygen, the result is a heart attack. A piece of plaque can also break off and travel to the brain, causing a stroke.
What’s different about heart disease in women
Let’s look deeper into each of the quiz questions:
Cardiovascular (heart) disease is the number one killer of women. Yet only 56% of women are aware that heart disease causes about 1 in every 5 female deaths.(3,4) A lack of knowledge and awareness is a risk factor in itself.(7) A risk factor is something that increases the chances of developing a disease. Risk factors for both women and men include:(4)
High blood pressure
High cholesterol levels
Overweight or obese
Lack of exercise
Women also have additional unique risk factors that can contribute to their having heart disease:
Women have smaller arteries than men, so CAD develops differently and may require different treatment.(6)
If a woman develops endometriosis, or experiences pre-eclampsia or gestational diabetes during a pregnancy, she can be at greater risk for getting heart disease in the future.(6)
Changes at menopause, such as increased testosterone levels and high blood pressure, can trigger heart disease.(7)
Autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis, increase the risk of heart disease. About 80% of people with autoimmune diseases are women.(7,8)
Stress and depression are both risk factors for heart disease, and both occur more frequently in women.(7)
Heart disease in women is not new. It became the number one killer of American women in 1908 and has remained in first place ever since.(9) It’s also the leading cause of death for women around the world; about 35% of all female deaths are related to cardiovascular disease.(10)
A woman can have a severe heart attack and not know it. Because women aren’t aware of their risk of heart disease, they can experience a severe heart attack without knowing it. This is called a “silent heart attack” and some studies have shown it is more common in women than men.(11) A silent heart attack can happen without any symptoms or maybe some mild symptoms. A woman may tell her health care provider that she’s been feeling extremely tired for a while. Since women tend to take care of others before themselves, they attribute the fatigue to managing a household or working full-time. Both the woman and her health care provider may agree that stress or anxiety is the cause and dismiss it.(11)
Other examples are when a woman reports that she had the flu or that she ate something that caused indigestion. When the health care provider investigates and orders an ECG, the results show the woman had a heart attack weeks or months ago.(11)
Symptoms of a heart attack can be different for women from men. Most people associate a heart attack with crushing chest pain, often described as “an elephant standing on my chest.” For many women experiencing a heart attack, classic symptoms like this don’t always appear. One of the challenges for health care providers is recognizing that women can have different signs and symptoms during a serious heart attack. These can be more subtle than those seen in men; unless the health care provider is familiar with the difference, a woman may not receive a rapid diagnosis and treatment.(7)
While 87% of women experience chest pain or discomfort(12), they may also complain of other symptoms:
Pain in the back, between the shoulder blades, or upper abdomen (4,7,12)
Pain in the jaw, neck, or throat (4)
Shortness of breath (7)
Dizziness or feeling lightheaded (14)
Indigestion or acid reflux (7)
Nausea and/or vomiting (4)
Sudden or extreme fatigue (4)
In a study of adults aged 18 to 55 years who were hospitalized for serious heart attacks, 62% of the women had three or more symptoms besides chest pain, compared to 55% of the men. About 30% of the women had tried to get medical care before they were hospitalized; only 22% of the men did. However, 53% of the women’s health care providers did not think the symptoms were heart-related, compared to 37% of the men.(12)
After a heart attack, a woman is more likely to die within a year than a man. Heart attacks in women are often more severe than men(14), and women spend more time in the hospital following the heart attack.(1,13)
In the first year following their heart attack, women are 50% more likely to die than men.(14) During the first five years, they are almost twice as likely to have another—possibly fatal-heart attack(14) or develop heart failure.(2) One of the reasons women don’t do as well as men is that they average about 10 years older than men when they have their first heart attack, about 72 years-old, compared to 61 years-old for men.(2)
Another reason is that, partly because of the age difference, women have more complicated health histories at the time of their heart attack. Conditions like high blood pressure, chronic obstructive pulmonary disease (COPD), and diabetes can contribute to the development of heart failure following the heart attack.(2)
Finally, women don’t always get appropriate care after their heart attack. They are less likely to receive prescriptions for important medications that control blood pressure, lower cholesterol, or prevent blood clots.(2 ,5) Even in the hospital, 84% of men are seen by a cardiovascular specialist, compared to 73% of women.(2)
Older women with heart disease are more likely to develop dementia. Studies have shown that women 65-79 years-old who’d had a heart attack or had developed heart disease were at a higher risk of dementia.16 Women who had survived a heart attack were twice as likely to have issues with thinking and memory.(2)
In a study that lasted 25 years, researchers at Johns Hopkins University studied 16,000 people (both women and men) who were between 44 and 66 years-old when the study began. More than 1,500 people developed dementia. The researchers found a connection between those who had cardiovascular conditions, like high blood pressure and diabetes, were more likely to be diagnosed with dementia.(17) There was also a higher risk for those who had prehypertension (when blood pressure is higher than normal) and those who smoked.(17)
And one other study followed 1,450 women and men for four years. The participants were in their 70s and 80s at the start of the study, without problems in memory or thinking. At the end of the study, 348 people had some mild cognitive impairment, such as difficulty making decisions, finding the right words, or getting around a familiar place. Some experienced memory loss, too.(18) The researchers found that 94 of the participants—27%—had vascular dementia, which is related to some type of cardiovascular condition. Women with heart disease were three times more likely to have this type of dementia than men.(18)
Begin by taking charge of your life
Every woman should keep a record of her blood pressure, cholesterol level, and blood sugar numbers; ideally, you’d begin to do this you’re about 30 years-old. No matter your age, it’s never too late to keep track of these results.
Maintaining a healthy lifestyle is also important:(4)
moderate (or no) alcohol
solid work-play balance
During your annual physical appointment, your health care provider will review your medical history and do a risk assessment for heart disease. They look at the laboratory results of your cholesterol and blood sugar, along with your blood pressure. They will compare all of these with your previous numbers to see if there is a new trend.
Your health care provider also considers your gender, age, weight, smoking habit, family history, and overall health to calculate your risk of heart disease and chance of a heart attack.(4) This traditional method is important and helpful in making lifestyle and medication adjustments.
The heart test that may be useful for women
Given the different risk factors and poor outcomes for women after a heart attack, a relatively new test can more precisely determine the risk for heart attack and stroke. Preventing a heart attack or stroke is a thousand times better than treating it. The test that can provide accurate information about risk is called a coronary artery calcium (CAC) scan. It’s also known as a heart scan, a coronary calcium scan, or a CT calcium score. A CAC can help identify if someone is at risk for heart disease before there are any signs or symptoms. A CAC is a low-dose CT scan that uses special X-ray technology to take thin cross-sectional images of your heart, called slices. When the slices are combined, they create a 3-D look at your heart to measure the plaque deposits in the blood vessels that bring oxygen to the heart.(19)
Plaque is made of cholesterol, calcium, fat, and waste products. It causes deposits in the blood vessels called atherosclerosis. As it builds up, it coats the inner wall of the blood vessels, causing the channel to narrow. When this happens, blood flow is reduced, restricting the amount of oxygen and essential nutrients to the heart and body.(20)
The CAC “looks” at the plaque deposits in the four coronary arteries and assigns a score that tells how much calcium is present. The level of calcium (calcification) in each artery is classified as none, minimal, or moderate. With this score, your health care provider can prescribe an appropriate medication, as well as recommend lifestyle changes that might avoid a heart attack.
A CAC scan increases your health care provider’s ability to go beyond traditional risk factors and work with you to create an individualized treatment plan.
Preparing for your CAC scan with a low-dose CT scan is easy. You can eat and drink up to your appointment time, although you may be asked to avoid any caffeine for 4 to 12 hours before the scan. You can also take your prescribed medications as usual.
Who should get a coronary artery calcium (CAC) scan?
The CAC scan isn’t yet part of standard or preventive screenings. But in 2019, the American Heart Association (AHA) and the American College of Cardiology (ACC) established guidelines about treating cholesterol levels to avoid building up dangerous plaque in the arteries. The guidelines include using a CAC score to make decisions about medical management.
The CAC recommendations include:(21,22)
40- to 75-year-olds when risk status is uncertain
Women 60- to 80-years old and men 55- to 80-years-old with few risk factors but who might benefit from cholesterol-lowering medications (statins)
40- to 55-year-olds who have a 5% to 7.5% risk of developing heart disease within the next 10 years
Anyone who is reluctant to take statins and needs an accurate risk profile
Paying for your CAC scan
Check with your health insurance company. Most health insurance plans do not cover a CAC scan. Medicare does not cover it, either. HeartLung™ offers a comprehensive and affordable low-dose CT scan that provides results of the heart scan, as well as several other organs and body areas. During the scan, you’ll be placed in a comfortable position. Small electrodes will be placed on your fingers. The scan itself will take about five minutes, then you’re free to go and resume all your normal activities.
One of the many benefits about a HeartLungTM scan is that after you download the HeartLungTM app on your phone, you answer a few simple health questions, find a convenient location, and schedule your appointment.
Here’s what else is checked during your HeartLung screening scan
When you choose a low-dose CT scan from HeartLungTM you will get much more than the results of your heart scan. Our goal is to prevent disease or identify it in early stages.
We offer an exclusive Auto-10TM scan that will provide ten detailed reports on areas of your body that cannot be evaluated by the usual physical examination or blood tests. At the same time as your heart scan—and with the same safe procedure—we can do an “internal check” and provide the following detailed reports: [Link to Auto-10 descriptions]
Coronary Artery Calcium
Cardiac & Great Vessel Sizes
Lung Cancer Nodule Detection
Emphysema Score & Airway Measurement
Thoracic Fat & Muscle Measurements
Breast Density Measurement
Fatty Liver Disease Detection
Enlarged Lymph Nodes, Thymus & Thyroid
Hiatal Hernia & Esophageal Masses
Bone Mineral Density Measurement
Your HeartLungTM Auto-10TM scans are analyzed using Artificial Intelligence (AI), comparing them to thousands of other CT scans. Then a radiology physician will review them as part of our quality process. The detailed reports you receive are accurate and unbiased.
Another benefit of your HeartLung scan is that the smallest possible dose of radiation is used to obtain all Auto-10TM results. The procedure uses less than 1.5 mSv of radiation, about the same as six months of the background radiation you’re normally exposed to. By avoiding having separate CT scans, your radiation exposure in minimized.
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Cho L. Women or Men—Who Has a Higher Risk of Heart Attack? Cleveland Clinic, Cleveland, OH. https://health.clevelandclinic.org/women-men-higher-risk-heart-attack/ (Accessed 11 September 2021)
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