CVD in Women: Why does Cardiovascular Disease affect Women differently?

Cardiovascular disease (CVD) is a critical health issue for women, responsible for 35% of female lives lost annually – more than all cancers.¹ It is a common misconception that men are more affected by heart diseases.¹ A significant challenge in diagnosing heart disease in women is that their symptoms can be different from those typically seen in men, frequently leading to misdiagnosis.¹ Additionally, women’s underrepresentation in clinical trials exacerbates this issue.¹
However, the tide is changing and there is an increasing focus on women’s heart health among experts and the public. This article looks at the unique aspects of cardiovascular disease in women. By understanding them, we can raise awareness and help with the timely detection of symptoms, as well as diagnosis.

What is CVD in Women?

Heart disease is a broad term that includes a range of heart-related issues, collectively known as cardiovascular disease (CVD). This term covers conditions affecting both the heart and blood vessels.² CVD in women specifically addresses cardiovascular conditions affecting people assigned female at birth.³  Women can experience heart disease differently from men due to…

• …anatomy: Women have smaller blood vessels and heart chambers, with thinner ventricular walls, which may influence how they experience heart disease compared to men.³
• …blood count: Women have fewer red blood cells, resulting in less oxygen being carried throughout the body.³
• …hormonal differences: Higher levels of estrogen and progesterone in women further impact cardiovascular health, distinguishing their risk factors and symptoms from men.³
• …cardiovascular adaptations: Women are more prone to sudden drops in blood pressure when experiencing changes in altitude or quickly standing up, leading to dizziness or lightheadedness due to less robust blood pressure regulation.³

Symptoms of Heart Attack in Women

The symptoms of cardiovascular disease can differ based on the specific heart condition. In this section, we will highlight the signs of heart attack in women, who unfortunately face a higher risk of fatality from heart attacks compared to men.⁴

What are the signs of a heart attack in women?

While classic symptoms of heart disease, such as chest pain, feelings of pressure, or discomfort, occur in both sexes,¹ women often experience additional symptoms such as…

• …shortness of breath.
• …dizziness or faiting.
• …feeling hot or flushed.
• …indigestion.
• …fast heart rate.
• …numbness in hands or fingers.³

Where do the symptoms occur?

Women experiencing a heart attack often feel chest pain described as pressure, squeezing, or tightness.⁵ This discomfort is frequently accompanied by pain in the neck and throat⁵ and can extend to the shoulders, jaw, arms, abdomen and back.¹ As a result, these symptoms are often mistaken for everyday issues like heartburn or indigestion.¹

When do the symptoms occur?

Another notable difference between the sexes is the time when the symptoms occur. In women, heart attack symptoms are more likely to occur during periods of rest or routine activities.⁵ In contrast, men typically experience worsening angina during physical exertion, which then subsides when they are at rest.⁵  Recognizing gender-specific symptoms is crucial for timely diagnosis and treatment.

Early Signs of Heart Disease in Women

Understanding the early warning signs of cardiovascular disease (CVD) in women is essential for preventing heart disease. These signs are known as prodromal symptoms.³ They can occur before the more obvious symptoms of cardiovascular disease and can manifest hours, weeks, or even months before a heart attack.³ The most common prodromal symptom is unusual fatigue that has no recognizable cause. If you experience this type of fatigue, take it seriously and consult your doctor.³ In addition to fatigue, there are other early warning signs you should not ignore:³

• feelings of anxiety
• frequent indigestion
• rapid heart rate
• changes in thinking or memory that make you seem foggy
• loss of appetite
• breathing problems at night

You might also experience tingling, numbness or burning in your hands, fingers or arms, as well as coughing, more frequent or severe headaches, chest discomfort and pain in your jaw or teeth, and a feeling of weakness or heaviness in your arms.³
These symptoms can come and go and often disappear on their own, which makes them easy to be overlooked.³ Take these warning signs seriously and pay attention to what your body is telling you. Don’t wait for symptoms to persist. Seek help and contact a healthcare professional as soon as you notice anything unusual.

Women and CVD: Risk Factors

Both men and women can develop (or worsen) cardiovascular disease due to factors like high blood pressure, an unhealthy diet, obesity, lack of exercise, and high cholesterol.¹ However, women face additional risk factors that can increase their susceptibility to CVD.¹ For example, women with diabetes are at a higher risk of heart disease compared to men with the same condition.¹ Stress and depression also have a more pronounced impact on women’s hearts, and smoking significantly elevates their risk of cardiovascular disease.¹
Hormonal changes after menopause, especially the drop in estrogen levels, increase the risk of cardiovascular diseases in smaller blood vessels.¹ Furthermore, pregnancy complications such as high blood pressure or diabetes can increase a woman’s long-term risk of developing cardiovascular conditions.¹

Testing and Treatment for Heart Disease in Women

Recognizing the symptoms of CVD in women is a crucial step towards prevention, but also recovery. Modern diagnostic tests, such as electrocardiograms (ECG), echocardiography, and CT scans, are available for both men and women.⁶ However, women often face delays in diagnosis or treatment because their symptoms are frequently misinterpreted.⁵
For example, a coronary angiogram is effective in detecting large pieces of plaque that cause obstructive coronary artery disease in men – but in women, smooth layers of plaque can also lead to this disease.³ If you experience symptoms but initial test results appear normal, be sure to request further testing to determine the true cause of your symptoms.
Women should also be mindful of potential issues with medications. They are more likely to be intolerant to ACE (angiotensin-converting-enzyme) inhibitors, commonly used to treat high blood pressure; and while statins effectively lower cholesterol levels in everyone, women may experience side effects more frequently.³

Prevention of CVD in Women

Cardiovascular disease affects some women more than others, but many heart attacks and strokes can be prevented with education and lifestyle changes.⁷ Simple steps like exercising more, eating healthier, and managing blood pressure can make a big difference.⁷ One of the most important steps is to avoid smoking, as it greatly increases the risk of heart disease.¹ Additionally, reducing stress through deep breathing, or regular exercise can improve heart health.¹
Regular check-ups based on a woman’s age and health status are crucial for early detection and management of potential heart issues. Consistent screenings for blood pressure, cholesterol levels, and other heart disease indicators can lead to early intervention and better outcomes.⁸
At Daiichi Sankyo, we are dedicated to improving women’s cardiovascular health by providing comprehensive information on the topic. This includes addressing the specific challenges women face in diagnosing and treating cardiovascular disease. Our goal is to empower women to take charge of their health.