• Gender Differences in Heart Disease

    Research on gender differences in heart disease and heart attack exists, but it can be difficult to translate and digest it all. Here, we break down some key research outcomes for you so you can take a proactive stance in your own heart health care. While some of this information may be disconcerting, the more you know about heart disease, the more you can partner with your doctor to take preventive steps and head off a heart attack before it happens.

    • Women develop initial symptoms of heart disease an average of ten years later than men.
    • Women tend to have heart attacks about 10 years later than men do, and don't fare as well after. According to the American Heart Association, 38 percent of women compared with 25 percent of men will die within one year of having a heart attack. One explanation for this difference includes the fact that therapeutic interventions such as coronary angioplasty with stenting and coronary artery bypass graft surgery can all carry higher complication and mortality rates for women.
    • Women are less likely to recognize the symptoms of a heart attack and seek treatment right away
    • Men who go to their doctor complaining of chest pains are more likely to get an exercise electrocardiogram (ECG) than women in the same situation. An exercise ECG is a test that measures the heartbeat's electrical activity while the patient walks on a treadmill. It is the gold standard for noninvasive testing in patients with suspected heart disease but studies have shown that it may not be as accurate in detecting heart disease in women. Women with existing heart disease are more likely than men to have a normal ECG. The issue, according to American Heart Association research, is that an exercise ECG is not ideal for detecting heart disease in just one vessel, which is the kind women tend to get. Inaccuracies in results also can be caused by older women's physical limitations; some people cannot exercise intensely enough for the exam to be effective.
    • Other testing options do exist for women, however, including stress echocardiography, a test that uses ultrasound to detect heart disease, or nuclear imaging with the exercise ECG (also known as radionucleide stress testing) to get a more comprehensive and accurate picture of a woman's heart health. Another option available at Lahey is CTA, or cardiac CT angiography, a noninvasive imaging test that can detect coronary blockages. This exam is indicated for patients with chest pain and moderate risk factors for heart disease. Your doctor will help you determine what test or tests are most appropriate for you.
    • Women's hearts also differ electrically from men's hearts. Women tend to have a faster baseline heart rate. Beginning at puberty, women have longer QT intervals, which represent the time for both ventricular contraction (stimulation) and ventricular relaxation (recovery), than men. This makes women more susceptible to potentially lethal ventricular arrhythmias as a complication of therapy with certain drugs. Female family members with inherited long QT syndrome are more vulnerable to sudden cardiac death.
    • In addition, female hormones affect cardiac electrical properties, and fluctuations in these hormone levels during pregnancy, the menstrual cycle, and menopause may predispose women to develop supraventricular arrhythmias (abnormal heart rates that originate above the ventricles, within the sinus node or atrium).
    • Coronary heart disease rates in women after menopause are two to three times those of women the same age before menopause. This is because estrogen, which appears to have a protective effect in women, drops significantly after menopause. Hormone Therapy & Heart Disease Prevention in Women

    Hormone Therapy & Heart Disease Prevention in Women

    Several large-scale studies such as the Women's Health Initiative (WHI), the Postmenopausal Estrogen and Progestin Interventions (PEPI) and the Heart and Estrogen/Progestin Replacement Study (HERS) have shed light on the role of hormone therapy in coronary disease prevention in women. These studies have also highlighted the need for clinical trials regarding cardiovascular disease therapy specific to women.

    • The HERS study showed that estrogen plus progesterone did not provide cardiac protection for women with known coronary disease, despite favorable effects on lipid profiles. In addition, the WHI prematurely terminated its study of postmenopausal estrogen plus progesterone therapy because of an increase in adverse cardiac events in the group receiving therapy. Given these reported poorer outcomes, coronary prevention has become recognized as a crucial public health issue for women, in addition to being extremely important for individual patients regardless of gender.

    For more information and news on heart disease in women, visit our women's heart health library or see our helpful links page.

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