What does someone with heart disease look like? A stressed out CEO? A smoker over 50? Whatever image came to your mind, chances are it was of a male. We think of heart disease as a male problem, but did you know that more women die of heart disease than men? It’s now the leading cause of female deaths worldwide. Yet up until recently, two-thirds of all heart health research has focussed exclusively on men. What’s wrong with this picture?
If you’re a woman at risk of cardiovascular disease (CVD) there is good news – researchers are working to close the gender gap and prioritize female-based cardiac research. Let’s have a look at what the research is teaching us about female-specific heart disease factors – and how you can reduce your risk.
What the Gender Gap Means for Women’s Heart Health
Women’s Bodies Are Different
Compared to male physiology, women’s hearts and arteries tend to be physically smaller than men’s. Since plaque build-up in the arteries is a well known key factor in all heart disease, smaller arteries may mean that plack build-up can lead to serious issues faster in women than it does in men.
Different Plaque Deposits
It’s not just anatomical differences – the way that arterial plaques and injuries show up in women can be very different from men, delaying a heart disease diagnosis, or even making misdiagnosis more common. This may be why more women die from heart attacks than men, and why women are more likely to have second heart attacks in spite of regular check-ups.
Dismissive Diagnosis
Heart attack symptoms often look different in women. For example, the sharp chest pains of angina precede a heart attack in everyone, but women may have additional symptoms such as extreme fatigue, trouble breathing, and pain across the stomach and upper back. Not recognizing these red flags can lead to a dangerously delayed or incorrect diagnosis
The research tells a troubling story. When female patients report stress alongside recognized heart disease symptoms, they are significantly more likely than men to be given a diagnosis of anxiety. And research tells us this happens even when the same heart-related symptoms were reported as their male counterparts.
Less Risk Factor Screening
But it doesn’t end there. After receiving a heart disease diagnosis, women are not screened as often as men for depression. Research shows that depression is a key heart disease risk factor, and is almost twice as common in female heart disease sufferers as men. This crucial gap can increase womens’ risk for subsequent fatal heart attacks, and slow down recovery.
Different Hearts, Different Diseases
The term ‘heart disease’ or ‘cardiovascular disease’ goes way beyond heart attacks, and includes a host of different issues affecting the heart, blood vessels and arteries. Not surprisingly, some heart conditions affect more women than men. For example, 90% of all
Spontaneous Coronary Artery Dissection (SCAD) patients are women, and it accounts for 25% of all heart attacks in women under the age of 60. It is important for your health practitioner to be knowledgeable about the symptoms and risk factors that differ between their male and female patients.
What Special Risk Factors Do Women Have?
Many heart disease risk factors are the same for men and women, however they can vary greatly in the risk they pose each group.
Obesity & Smoking
Of the many shared factors, obesity and smoking are the ones that most often impact women more than men. In one study, obesity increased the risk of heart disease by 64% in women, compared to 46% in men. In another study, female smokers had a 25% higher risk of heart disease when compared with men.
Inflammation
Chronic inflammation is a factor too. Recent research shows that women who have inflammation-related health conditions are a higher risk of heart disease than men with similar inflammatory conditions.
Breast Cancer Treatment
Women receiving radiation for breast cancer are particularly vulnerable to heart disease, with studies showing higher rates of fatal heart disease.
Hormones, in Particular Estrogen
Hormones also come into play. We think of estrogen as the quintessential ‘female’ hormone that affects our periods, pregnancy, and menopause. But did you know that estrogen is intricately connected with cardiovascular health, the body’s inflammatory response and even insulin sensitivity?
Pregnancy
In pregnancy there are big changes in heart rate and blood pressure, which can increase the risk of a heart attack. Diabetes is also a key risk factor, and if Gestational Diabetes appears during pregnancy, the heart attack risk is increased further.
Menopause
Research shows that heart disease risk for women increases significantly after menopause. It is thought that higher estrogen levels pre-menopause provide a protective heart effect. Studies show that cholesterol levels tend to increase after menopause. Remember those small female arteries that can clog faster than men? More cholesterol means more heart disease risk.
BHRT
Many women undergo Bioidentical Hormone Replacement Therapy during or after menopause to mitigate risks and reduce symptoms, however research shows that for some women, these changing hormone levels can increase heart disease risk. This underlines the importance of working with a professional who is able to properly assess your body’s hormone replacement needs, follow you closely and test for any risk factors that could impact the forms of bioidentical hormone replacement appropriate for your unique body.
How You can Reduce Your Heart Disease Risk
In addition to quitting smoking and reducing stress, weight management is the most effective way for women to reduce their risk of being impacted by heart disease. Excess weight is hard on the heart, and is a stronger heart disease risk factor for women than men. Let’s look at a few simple ways to get on the path to heart health:
Get Moving
Current medical guidelines suggest that women should engage in a minimum of 2.5 to 3 hours per week of vigorous physical exercise. If that sounds like a lot, try breaking it up into exercise bites of 10 – 15 minutes each. Take a brisk walk during work breaks, take the stairs instead of the elevator, or have a personal dance party!
Eat More Plants
You don’t have to become a vegetarian or vegan to welcome more plant foods into your life. The key is to make it enjoyable by choosing fruits and veggies that you like, and get lots of variety. Think of veggies as the main course instead of the side dish – aim to have at least 60% of your plate covered with veggies. Summer is a great time to get gorgeous local produce. See what’s in season and don’t be afraid to try something new!
Eat Good Fats
When your body craves fat, it’s not actually asking for more chips. It really wants ‘good fats’ like those found in salmon, avocado, nuts and seeds. But if you don’t have these foods often, they’re not on your body’s radar. Try adding foods rich in healthy fats to your meals, and see if you notice a change in your fat cravings. Once your body gets to know these nutrient-dense foods it will start to request them more often!
Nutrients to Support Good Heart Health
Essential Fatty Acids
These ‘good fats’ are called Essential Fatty Acids (EFAs), and have been shown to significantly reduce the risk of developing heart disease. This supplement is especially important for women, as EFAs also help to build strong cells throughou the body and balance hormones.
Since estrogen levels are a key factor in womens’ heart health, EFA supplementation can play double duty! Ever wonder what’s so ‘essential’ about them? Our bodies can’t make them on our own, so we need to eat EFA-rich foods, or supplement with high-quality oils such as fish, hemp or flax seed oil.
Selenium
Studies show that low selenium levels are strongly linked to heart disease risk. Selenium is one of the most effective antioxidant supplements, protecting your heart, blood vessels and arteries from damaging free radicals. Brazil nuts are by far the best food source of selenium, with a handful providing a thousand percent of the recommended daily minimum!
Women (and men!) It’s time to prioritize your heart health!
At the Marsden Centre, our expert Integrative Medical Practitioners and Naturopathic Doctors support the patient, not the disease. Get in touch and let’s discuss your health history and risk factors, run some targeted labs for a clear picture of what’s happening inside your body and design a personalized treatment plan. Women lead with the heart, make sure yours stays healthy.
Resources:
Canadian Women’s Heart Health Centre: http://cwhhc.ottawaheart.ca/
Barish R, Lynce F, Unger K, Barac A. Management of Cardiovascular Disease in Women With Breast Cancer. Circulation. 2019;139(8):1110-1120. doi:10.1161/CIRCULATIONAHA.118.039371
Garcia M, Mulvagh SL, Merz CN, Buring JE, Manson JE. Cardiovascular Disease in Women: Clinical Perspectives. Circ Res. 2016;118(8):1273-1293. doi:10.1161/CIRCRESAHA.116.307547
Kane AE, Howlett SE. Differences in Cardiovascular Aging in Men and Women. Adv Exp Med Biol. 2018;1065:389-411. doi:10.1007/978-3-319-77932-4_25
Karvinen, S. et al. (2019) Menopausal Status and Physical Activity Are Independently Associated With Cardiovascular Risk Factors of Healthy Middle-Aged Women: Cross-Sectional and Longitudinal Evidence. Front. Endocrinol. doi.org/10.3389/fendo.2019.00589.
Leonard EA, Marshall RJ. Cardiovascular Disease in Women. Prim Care. 2018;45(1):131-141. doi:10.1016/j.pop.2017.10.004
Mattina GF, Van Lieshout RJ, Steiner M. Inflammation, depression and cardiovascular disease in women: the role of the immune system across critical reproductive events. Ther Adv Cardiovasc Dis. 2019;13:1753944719851950. doi:10.1177/1753944719851950
Patel H, Chandra S, Alexander S, Soble J, Williams KA Sr. Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management. Curr Cardiol Rep. 2017;19(10):104. Published 2017 Sep 8. doi:10.1007/s11886-017-0909-z
Rosano GM, Spoletini I, Vitale C. Cardiovascular disease in women, is it different to men? The role of sex hormones [published correction appears in Climacteric. 2018 Feb;21(1):92]. Climacteric. 2017;20(2):125-128. doi:10.1080/13697137.2017.1291780
Saeed A, Kampangkaew J, Nambi V. Prevention of Cardiovascular Disease in Women. Methodist Debakey Cardiovasc J. 2017;13(4):185-192. doi:10.14797/mdcj-13-4-185
Heart and Stroke Foundation of Canada: https://www.heartandstroke.ca/
World Health Organization: https://www.who.int/gho/women_and_health/mortality/situation_trends_causes_death/en/