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School of Medicine
Heart Disease: Differences in Men and Women
Lili Barouch's, M.D. areas of expertise include peripartum cardiomyopathy and congestive heart failure.
Women have unique heart attack symptoms
A significant challenge for diagnosing women with heart disease is the lack of recognition of symptoms that might be related to heart disease, or that don’t fit into classic definitions. Women can develop symptoms that are subtler and harder to detect as a heart attack, especially if the physician is only looking for the "usual" heart attack symptoms.
“Women are much more likely to have atypical heart attack symptoms,” says Dr. Lili Barouch, Assistant Professor of Medicine, Division of Cardiology, Johns Hopkins School of Medicine. “So while the classical symptoms, such as chest pains, apply to both men and women, women are much more likely to get less common symptoms such as indigestion, shortness of breath, and back pain, sometimes even in the absence of obvious chest discomfort.”
Determining heart disease risk in women
Women and men share many heart disease risk factors, but recent studies are showing what previous male-focused studies have not shown: Women also have their own unique heart disease risk factors.
Traditional risk factors common to both women and men:
- High blood pressure
- Family history
- Metabolic syndrome – the co-existence of high blood pressure, obesity, and high glucose and triglyceride levels
- High levels of C-reactive protein – a sign of inflammatory disease that can occur along with other cardiovascular risk factors
Some risk factors that relate specifically to women or that can affect women disproportionately include:
- Relatively high testosterone levels prior to menopause
- Increasing hypertension during menopause
- Autoimmune diseases such as rheumatoid arthritis – more common in women than in men
- Stress and depression – also more common among women
- Low risk factor awareness – Lack of recognition of many of the above conditions as risk factors for heart disease is a risk factor in itself
Lower the risk factors you can control
The first step to lowering cardiovascular risk is to raise your awareness of the risk factors and symptoms that are particular to women. The next step is to take actions and practice daily behaviors that lower the risk factors you can control.
- Avoid smoking.
- Stick to a healthy, low-saturated-fat diet that is high in fiber and low in fatty, processed foods.
- Several times a week, follow a supervised exercise regimen that is both challenging and motivating:
- Benefits of regular exercise include lower blood pressure, lower risk of diabetes, healthier body weight, and stress reduction.
- Exercise at least 3 times per week for at least 30 minutes. Even better, build up to 4-6 times per week for 45 minutes or more.
- Consult with your physician about cardiovascular screening based on your family history and risk factors.
- Keep track of your cholesterol.
Learn more about heart disease risk factors and symptoms that are unique to women, and unique to you
Because heart disease and heart attack symptoms in women sometimes don’t include the “classic” angina or chest pain, Dr. Barouch stresses the importance of paying attention to your body, and not being shy about asking questions. “If you don’t feel right, and especially if you have symptoms such as difficulty breathing, persistent nausea and abdominal pain, or any other unusual symptoms, you should talk to your doctor and not just shrug it off.”