Cardiovascular Disease in Women: Spotlighting Unique Symptoms, Risk Factors

Although often considered a men’s health issue, cardiovascular disease (CVD) does not discriminate - in fact, CVD is the number one killer of both men and women in the United States. Approximately one of every three female deaths is linked to CVD. However, data show that while the public awareness of this statistic increased during the 1990s, it has plateaued as of the early 2010s.

As a result, there is an unmet need regarding the increased recognition of the prevalence of both traditional risk factors and how they differ in women than men, as well as the actual presenting symptoms.

It has additionally been shown that women are less likely to receive preventive treatment or guidance or lifestyle changes for their cardiovascular health, compared to men at similar risk of CVD.

Here is a rundown of those differentiations, featuring perspectives from expert clinicians on women’s heart health.

Traditional Symptoms and Risk Factors

Numerous symptoms are classified as being prevalent in both men and women:

• Chest Discomfort, described as “an elephant sitting on your chest”
• Shortness of Breath
• Fatigue
• Nausea
• Lightheadedness
• Pain in Left Arm/Jaw
• Heart Palpitations

Additionally, some risk factors for both men and women can include:

• High Blood Pressure
• High Cholesterol
• Diabetes
• Age
• Ethnicity
• Social Status

How Women Differ From Men

Despite this, often, women have no symptoms prior to a heart disease diagnosis. Previous data from 2019 show only 6% of women between the ages of 25 - 34 years old were able to recognize symptoms related to heart disease.

In addition to traditional symptoms, clinicians have supported women as having symptoms of heart disease, unrelated to traditional chest pain. These symptoms consisted of:

• Angina
• Pain in the neck, jaw, or throat
• Pain in the upper abdomen or back
• Nausea or vomiting
• Dizziness
• Fatigue
• Heartburn

“It's not the same feeling as classical symptoms,” said Valentyna Ivanova, MD, MD, AGH McGinnis Cardiovascular Institute, Allegheny Health Network. “When a woman comes in and says I don’t feel well, there is always supposed to be in the back of your mind not to miss something that’s more than what is presenting. Plus, women have the tendency to downgrade symptoms.”

Anita Radhakrishnan, MD, AGH McGinnis Cardiovascular Institute additionally noted that two out of three women do not present with a lone symptom at the time of heart attack.

“Women don't even show up because they don't know what the symptoms are, or their symptoms seem a little bit atypical, and they just kind of ignore it,” she said. “If we don't show up to get evaluated, because we feel something is wrong, and we just kind of keep ignoring it, that's really what leads to increased numbers.”

Risk Factors for Women

In order to recognize symptoms of CVD, it is likewise necessary to recognize the unique risk factors for women to ultimately better outcomes and spread awareness to the affected patient populations.

Here are 8 risk factors for CVD in women:

1. Age

The average lifetime risk of developing CVD in women at 50 years of age is about 40%, where the percentage rises as the number of risk factors increases. Additionally, data suggest a leveling in the improvements in incidence and mortality of coronary heart disease, specifically among younger women (<55 years).

2. Menopause

At the onset of natural menopause around 50 - 52 years, the risk of heart disease increases dramatically. Reduced levels of estrogen increases the risk of developing disease in smaller blood vessels, causing plaque and blood clots.

3. Pregnancy

In pregnancy, women can develop gestational hypertension before 20 weeks, which can lead to preeclampsia after 20 weeks, which can put women at a much higher risk for heart attack or stroke later on. Additionally, gestational diabetes increases the risk of developing type 2 diabetes by 7-fold, which is a major risk factor for subsequent ASCVD and additionally raises CVD risk

4. Mental Health

Depression is more common among young women, who have been unrepresented in studies of CVD and have high mortality rates after acute myocardial infarction. Women may carry high levels of stress, which is linked to heart disease.

5. Hypertension

Data show a higher prevalence of hypertension in women over age 60 compared to men and is considered to be less well controlled and less likely to meet blood pressure targets.

6. Obesity

More than 2 in 3 adults in the US are considered to be overweight or obese, with the prevalence of obesity being higher among women than men. According to the Framingham Heart Study, obesity increased the relative risk of coronary artery disease (CAD) by 64% in women. Additionally, the prevalence of inactivity and sedentary behaviors is higher among women, which can lead to higher rates of heart disease.

7. Smoking

Smoking is shown to be a greater risk factor for women compared to men, particularly for young women and increases the risk of CVD. Women had a 25% increased risk for CAD from cigarette smoking.

8. Family History

Data show CVD carries a genetic component, increasing the risk of development if a patient’s mother was diagnosed before 65 years old or father before 55 years old. A family history of diabetes, high blood pressure, and high cholesterol can also increase risk of CVD.

“If you know that you had a family history of early disease, be alert,” Ivanova said. “Ask for primary prevention and go have a talk with a cardiologist or with a primary care physician on risks, because you might have predisposing factors that need to be treated earlier than later.”