Take This to Heart: Women and Heart Disease

Did you know that heart disease is the leading cause of premature death for women in Canada? In fact, women are five times more likely to die from heart disease than from breast cancer.

Heart & Stroke shared these and other stats in an eye-opening report, Ms. Understood, released in 2018. Its aim was to raise awareness of how heart disease affects women in Canada, and how women’s experience differs from that of men. These are some of the highlights:

• In Canada, a woman dies of heart disease every 20 minutes.
• The early signs of an impending heart attack were missed in 78% of women.
• Women are more likely to experience delays in treatment.
• When women have a heart attack, they are less likely than men to see a cardiologist. Women are also less likely to get a referral for a cardiac rehabilitation program.
• Some of the tests used to diagnose a heart attack are less effective for women. For example, the cardiac exercise stress test (treadmill test) is less sensitive for women, especially younger women.
• Women are less likely to get bypass surgery and stents to restore blood flow, to be prescribed statins to help prevent a second heart attack, or receive anti-clotting therapies.
• Women who have a heart attack are more likely to die or have a second heart attack compared to men.
• Two-thirds of clinical research about heart disease focuses on men.

Source: Heart & Stroke 2018 Heart Report

Signs of heart attacks in women

A heart attack, also known as a myocardial infarction, happens when one of the coronary arteries that supply blood to the heart becomes blocked, usually by a blood clot. As a result, the heart muscle is deprived of oxygen, and this can cause permanent damage. Sometimes a heart attack is fatal.

In movies and on television, heart attacks are often depicted as coming on suddenly, causing people to clutch at their chests in pain and then collapse. This scene is so common that doctors have a name for it: the Hollywood Heart Attack. In real life, however, the signs of a heart attack often vary, and what’s happening isn’t always so obvious.

According to Heart & Stroke, signs of a heart attack include: chest discomfort (pressure, squeezing, fullness or pain, burning or heaviness), sweating, discomfort in the upper body (jaw, neck, shoulder, back, arms), nausea, shortness of breath and light-headedness.

In both men and women, chest pain or discomfort is the most common symptom. However, the pain may not be severe or sudden. In fact, some people experience only mild chest pain or discomfort, and some don’t feel it at all. Others may experience only one or a few of the other symptoms.

In women, the small blood vessels of the heart are more likely to be affected than the major coronary arteries. As a result, women are more likely to experience chest discomfort than a crushing pain. Women also commonly report shortness of breath, fatigue, indigestion or nausea, back or neck pain.

Unfortunately, as Heart & Stroke reported, women whose pain isn’t severe, and women who experience only non-painful, non-specific signs such as nausea, fatigue or shortness of breath, are more likely to delay getting emergency medical help. And when women do seek help, they are less likely to get fast and aggressive treatment.

Risk factors for heart attack

Nine out of 10 Canadian women have at least one heart attack risk factor – yet most underestimate their risk. Knowing the risk factors can help women take steps to control them and improve their heart health.

What is a risk factor? It is any characteristic or attribute that increases a person’s likelihood of developing an illness or injury. Some risk factors are non-modifiable, meaning that we can’t change them. For heart disease, non-modifiable risk factors include age, gender, family history of heart disease, and ethnic background (Indigenous, Chinese, South Asian and Afro-Caribbean women are at higher risk and have poorer outcomes.)

Many other risk factors are modifiable, and we can take steps to reduce their impact. (For helpful information, see “Improve your heart health,” below.)

• Smoking
• Physical inactivity
• Stress
• Unhealthy weight (which can lead to high blood pressure, high cholesterol, diabetes and sleep apnea, all of which increase the risk of heart disease)
• Unhealthy diet
• Alcohol and drug abuse

Women have additional risk factors that don’t affect men:

• Menopause can increase a woman’s risk of heart disease, including changes that commonly follow, such as an increase in cholesterol and triglyceride levels, higher blood pressure, and an increase in central body fat.
• Hormone replacement therapy (estrogen) can increase the risk of heart attack and stroke.
• In some women, oral contraceptives increase the risk of high blood pressure and blood clots, especially in combination with smoking, already having high blood pressure, age over 40 and/or other blood-clotting disorders.
• During pregnancy, certain complications can increase the risk of heart disease and stroke. These include high blood pressure, pre-eclampsia and gestational diabetes.

Improve your heart health

Show your heart some love – talk to your physician about your individual risk factors and learn what you can do about them. These resources can help you make lifestyle changes that will help reduce your risk of heart disease:

Heart disease (Heart & Stroke)

Eating Well with Canada’s Food Guide

Canadian Physical Activity Guidelines for Adults (18-64 years)

Canadian Physical Activity Guidelines for Older Adults (65 years and older)

Break It Off (smoking cessation)

Canada’s Low-Risk Alcohol Drinking Guidelines (Canadian Centre on Substance Abuse)

If you think that you or someone else may be having a heart attack, call 9-1-1 immediately. Learn more from Heart & Stroke.