Why Do More Women Die of Heart Attack Than Men?

Heart attacks strike men at younger ages than women. But survival rates are worse in women. 

Her Health
4 min read
More women die of heart-related conditions than of breast cancer. 

Your biological sex can determine how a particular disease or health issue will impact you. A host of disorders such as Alzheimer’s, autism, UTIs and specific cancers, differ in their incidences among the sexes.

But in these, heart problems have a peculiar spot. Here’s why.

Heart attacks strike men at younger ages than women. But survival rates are worse in women.

According to a 2017 study published in the Journal of the American Heart Association, a woman is three times more likely to die of a heart attack as compared to a man. Yet, their heart conditions remain undetected for the longest time. The same is the case for heart failure. What explains the discrepancy?

Heart Disease: The Greater Killer

The World Health Organisation’s (WHO) list of top 10 non-communicable causes of death among women, holds ischaemic heart disease (coronary heart disease) responsible for the maximum number of deaths in 2016.

In fact, cardiovascular disease is an important cause of death following breast cancer. Dr JoAnn Pinkerton, Director of The North American Menopause Society (NAMS), explained this link in a ScienceDaily report. "Heart disease appears more commonly in women treated for breast cancer because of the toxicities of chemotherapy, radiation therapy, and the use of aromatase inhibitors, which lower estrogen. Heart-healthy lifestyle modifications will decrease both the risk of recurrent breast cancer and the risk of developing heart disease.”

The Age Factor: Why Heart Disease Affects Women Later Than Men

If there has to be one answer, it is estrogen and the lack of it.

Dr Rahul Chhabria, Consultant Cardiologist at Jaslok Hospital and Research Centre, says,

“Before menopause, women are relatively more protected from heart diseases because of the hormones produced by their ovaries, especially estrogen. But after menopause, they are equally at risk as men, because the hormonal protection reduces to minimal.”
Dr Rahul Chhabria

FIT also spoke to Dr Rashi Khare, Consultant Cardiologist at Max Super Speciality Hospital, Shalimar Bagh, who said that cases of heart diseases among young people in their 20s, are usually all men. “The decline in estrogen is also why hormone-replacement therapy, which involves supplementing women with hormones that are lost during the menopausal transition, is often used for post-menopausal women with heart diseases.”

Another reason why women become more prone to heart diseases is weight gain, which in turn makes them more prone to high blood pressure, cholesterol and diabetes, among other issues. Professor Eva Gerdts who studied the incidence of heart failure in males and females, was quoted as saying, “If we see this from a life span perspective, we can see that obesity increases with age, and that this trend is greater for women than men. Obesity increases the risk of having high blood pressure by a factor of three. This, in turn, increases the risk of heart disease.”

Underdiagnosis, Neglect & Lesser Known Symptoms

One of the reasons why heart disease remains undetected in women is that the symptoms and signs they experience differ from the more ‘classical’ (male) ones.

Heart attack symptoms in women may not be the same as in men.
Heart attack symptoms in women may not be the same as in men.
(Photo: FIT)

Men, for instance, experience sudden and extreme chest pain that radiates to the arm and neck. But for women, these symptoms may not be so evident. In fact, it’s common for women to not even realize that they’ve suffered a mild heart attack or two in the past, until they finally visit a doctor when the condition has worsened. They either do not have any symptoms, or just some mild pains or discomfort in the chest, neck, jaw, throat or lower back. Heartburn, nausea, fatigue or vomiting are some other ‘unconventional’ symptoms, again, mostly experienced by women. Dr Rahul Chhabria says,

“You could call the symptoms in women ‘atypical’ because the general public is only aware of the male ones. Due to this, these signs are often ignored and not taken seriously.”
Dr Rahul Chhabria

These ‘atypical’ symptoms could be a reason why women are almost seven times more likely to be misdiagnosed and discharged in the middle of having a heart attack. Such a trend is indicative of gender biases in medicine and research, where studies have historically been conducted for, on and by men.

While these non-classical symptoms contribute to late diagnosis in women, a deeper analysis reveals the societal set-up and norms to possibly be the biggest reason behind the underdiagnosis. Dr Rashi Khare explains, “Women have traditionally been trained to take care of the house and family, even at the expense of their own health.”

“As homemakers, their day revolves around household chores and looking after the family members. And as working women, they are torn between the house and office, leaving no time and energy for themselves.”
Dr Rashi Khare

Another important fact that Dr Chhabria points out is the relative absence of women in cardiology. “In some families, women are hesitant in visiting a doctor in the first place. And when the doctor is a male, it may just aggravate their hesitance or shyness.”

All of this translates into a simple fact, he says. “This is why fewer women undergo medical procedures across the world, despite the incidence of the disease being the same in men and women.”

So when we talk about preventing heart disease in women — apart from ensuring they make healthier life choices like eating right, exercising, and abstaining from smoking or drinking — a little extra needs to be done. From unbiased research and creating a more conducive medical environment, to paying more attention to their health and symptoms at home; a concerted effort should be made — both in the sphere of the family as well as science.

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