Most women think cancer (particularly breast cancer) should be their number one health concern, but the facts are the facts. According to the American Heart Association, one out of three women in the United States will develop heart disease in her lifetime. And if the present trend continues, it will soon be one in two. That means women will have a 50-50 chance of developing heart disease.

One of the problems is that most women don’t recognize they’re at risk for heart disease, which has long been considered a “man’s disease.” As a result, the American Heart Association reports, women are less likely than men to recognize the symptoms of a heart attack, which are often different for women than men. They are also less likely to call 9-1-1 when they are having symptoms of an attack.

Not only do heart attacks in women frequently go unnoticed by women themselves, but they are often unrecognized by their doctors. A 2007 report in the journal Circulation demonstrated that even after a woman is diagnosed with a heart attack, she is less likely to get the standard medications that have been proven to save lives. This ultimately leads to higher death rates for women, especially younger women.

Worrisome research

Until the turn of the 21st century, the medical community did not know much about the risk of heart disease in women. Heart disease research was predominately focused on men. This continued, despite the fact that more women than men were dying of heart disease, and there was a notable decline in deaths from heart disease among men. 

In 1991, Bernadine Healy, MD, the first female director of the National Institutes of Health (NIH), became a champion for women and heart disease. She established a policy stating that if the condition being studied affected both women and men, the NIH would only fund clinical trials that included both genders. But the 1990s were not that long ago, and we are only just beginning to understand the gender differences that exist with heart disease.

Women still have worse outcomes than men if they are diagnosed with heart disease or undergo heart procedures. A 2002 report in the New England Journal of Medicine showed that women—especially African American women—are also more likely than men to die in the hospital after a heart attack. A 2006 study in the Archives of Internal Medicine demonstrated that women were less likely to get appropriate medications after being discharged from the hospital after having a heart attack. And a 2006 paper published in the journal Circulation showed that women were less likely to receive life-saving interventions such as angioplasty, stenting or bypass surgery, resulting in longer hospital stays and higher death rates. 

Heart disease differs for men and women

The research shows something we have always known: Men and women are different, even when it comes to heart disease. 

Consider this: Research in a 1990 issue of American Psychologist indicated that women often experience new or different physical symptoms of a heart attack as long as a month or more before experiencing the actual attack. The symptoms most commonly reported by women were unusual fatigue (70.6 percent), sleep disturbance (47.8 percent) and shortness of breath (42.1 percent). Surprisingly, 43 percent of women in the study reported having no chest pain during any phase of the attack. 

Several studies have demonstrated that, in general, women wait longer than men to go to an emergency room when having a heart attack. And physicians are slower to recognize the presence of heart attacks in women because “characteristic” patterns of chest pain and ECG changes are less frequently present. Instead of the classic symptom of chest pain, women, as well as people with diabetes and older adults, are more likely to suffer from shortness of breath, nausea, back pain and/or jaw pain when they are having heart attacks.

Women, take notice

Women need to be aware that heart disease is an equal opportunity aggressor. More women than men die of heart disease each year. Women are more likely than men to die from a heart attack, and more women than men die within one year of having a heart attack. In addition, statistics show that twice as many women than men end up disabled as a result of a heart attack. Heart disease should no longer be considered a “man’s disease.”

Editor’s Note: This article was created with permission from Saving Women’s Hearts by Martha Gulati, MD, and Sherry Torkos, BScPhm (Wiley 2011).