Heart disease is the leading cause of death among women in the United States, with more women than men succumbing to this condition annually. This disparity partly arises from the under-recognition of heart disease and its risk factors in women.
Rising Numbers of Heart Failure
Heart failure (HF) is becoming increasingly prevalent in the U.S. The American Heart Association (AHA) reports that as of 2017, 6.5 million Americans over the age of 20 have heart failure. This number is projected to rise by 46 percent, exceeding 8 million by 2030. Unfortunately, the survival rate remains low, with 50 percent of those diagnosed with HF expected to die within five years.
Heart Failure in Women
Heart failure affects about 3.6 million women, constituting roughly half of the heart failure population. There are significant gender differences in the recognition, diagnosis, and management of heart failure. The cardiovascular systems of men and women exhibit unique anatomical and physiological characteristics.
Types of Heart Failure
Heart failure is often associated with aging, putting older women at greater risk than men. Women are more likely to develop diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), where the left ventricle stiffens and cannot relax properly between beats. This impairs the heart’s ability to refill with blood. In contrast, systolic heart failure involves a weakened heart that cannot contract with sufficient force to supply the body with oxygenated blood.
Common Causes of Heart Failure in Women
Postmenopausal women commonly develop heart failure due to:
- Hypertension (high blood pressure)
- Heart valve disease
- Diabetes
- Coronary artery disease
Other less common causes include heart infections, previous heart attacks, autoimmune disorders, drug side effects, alcohol abuse, smoking, and stress.
Symptoms of Heart Failure in Women
While men and women share many heart failure symptoms, women often experience additional, less typical symptoms. Common signs include:
- Chest pain: Uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can last a few minutes or come and go.
- Pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
- Shortness of breath: This can occur with or without chest discomfort.
- Cold sweat, nausea, or lightheadedness
Less Common Symptoms in Women
Women may also experience:
- Shortness of breath upon exertion (dyspnea)
- Nausea and vomiting
- Back or jaw pain
- Sleep disturbances and fatigue
Women often have a poorer quality of life with heart failure, including more difficulty exercising and experiencing edema (swelling). Symptoms can sometimes be misinterpreted as other conditions, like COPD or asthma, leading to inappropriate treatments with nebulizers and inhalers.
Diagnostic and Treatment Challenges
Heart disease in women can often be “silent” with missed or misinterpreted symptoms. Women are less likely to be referred for specialty care or diagnostic testing compared to men, and they undergo fewer procedures such as implantable cardioverter defibrillators (ICDs), revascularization, and cardiac resynchronization therapy (CRT).
Although the same diagnostic tests are used for both genders, the results may differ. For instance, normal values for heart measurements should vary according to gender, age, and body surface area but are not always considered. Biomarkers like natriuretic peptide levels (BNP) tend to be higher in women and vary with age.
Additional Considerations
- Depression: Common among women with heart failure, increasing their risk of developing heart failure post-heart attack.
- Chemotherapy: Over 2.2 million women in the U.S. have received chemotherapy for breast cancer, which is recognized as a risk factor for heart failure due to its cardiotoxicity.
- Under-representation in Research: Women are underrepresented in clinical trials, resulting in treatment advances that more often apply to men.
Need for Gender-Specific Studies
Further research is crucial to understand the causes of heart failure and develop targeted treatments for women. Recognizing gender differences and their impact could significantly improve future heart disease treatment for women.
Heart-Healthy Habits
To protect your heart, adopting heart-healthy habits is essential. This includes:
- Eating a balanced diet
- Exercising regularly
- Getting adequate rest
- Avoiding smoking
These steps can significantly improve general health and reduce the risk of heart disease.
By understanding the symptoms, risks, and necessary steps for prevention and treatment, women can better manage their heart health and seek timely medical care when needed.
