Women and Heart Disease

Overview 
Heart Attack Symptoms for Women vs. Men 
Gender Differences 
Surgical Treatment 

Heart disease is the leading killer of women, but many do not realize they are at risk. Heart surgeon Jennifer Lawton, MD, reviews symptoms, risk factors and prevention in this video produced by Barnes-Jewish Hospital. Click here for  Barnes-Jewish video Library and other videos on heart disease. 

Overview

The American Heart Association (AHA) reports that heart disease is the number 1 killer of women over 25 and offers the following statistics:

  • Cardiovascular disease (CVD) kills nearly 500,000 women each year — more than the next seven causes of death combined.
  • About one in every 2.6 women will die of heart disease or stroke, compared to one in every 30 women who will die of breast cancer.
  • CVD is a particularly important problem among minority women. The death rate due to CVD is higher in black women than in white women.
  • In every year since 1984, the number of deaths due to CVD for women has exceeded those for men.

Despite these statistics, AHA “Go Red for Women” surveys indicate misperceptions still exist. As recently as 2006, only 55% of women were able to identify CVD as the leading health threat for women, and approximately 30% of women underestimated their own personal risk of cardiovascular disease.

An article in the medical journal Circulation found that physicians also were more likely to underestimate the risk of cardiovascular disease in women. Primary care physicians were significantly more likely to assign intermediate-risk women to a lower risk category than men with identical risk profiles. In the online study of 500 randomly selected physicians, only one in five knew that more women than men die from cardiovascular disease each year.1

Differences in Heart Attack Symptoms for Women and Men

Women and men often respond differently to a heart attack. Women are more likely to delay seeking emergency treatment because they are less likely than men to believe they're having a heart attack.

Women and men share the following classic heart attack symptoms:

  • Discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back
  • Pain or discomfort in other areas of the upper body such as the shoulder, neck or arms
  • Other signs including sweating, nausea or light-headedness

However, women more often experience subtle, atypical signs – fatigue, shortness of breath, discomfort in the chest or upper body and pain in the abdominal region – that frequently mimic heartburn and other health problems.

Other Gender Differences in Heart Disease

On average, women with coronary heart disease are 10 years older than men who have the disease. Women also are more likely to have multiple risk factors (such as diabetes and vascular disease) and to have silent heart attacks. They are more likely to experience sudden death than men.

Medical research has shown that early mortality (in-hospital or 30-day) after coronary artery bypass graft (CABG) surgery is greater in women than men.2-5 In an article published by Circulation in 2002, Vaccarino and coworkers found that although the death rate following bypass surgery was higher in women of all ages, sex differences were more pronounced in younger patients. Women under 50 years of age were three times more likely to die than men (3.4 percent vs. 1.1 percent) and between 50 and 59 were 2.4 times more likely to die than men (2.6 percent vs. 1.1 percent).6

Research hasn't determined why women have higher mortality rates after CABG surgery; however, women who have undergone the surgery have been shown to have similar long-term benefits compared to men.7

Surgical Treatment of Heart Disease in Women

Several studies have shown good results in women with off-pump coronary artery bypass (OPCAB) surgery, performed without placing the patient on a heart-lung machine. In three studies — including one at Barnes-Jewish Hospital from 1996-2002 — women had lower mortality rates with OPCAB than they did with on-pump CABG.8,9

In addition, the selection of certain types of grafts for a CABG procedure may benefit women patients. Although there is a known survival benefit associated with the use of the left internal mammary artery, this arterial graft is used less frequently in women.10,11 A smaller percentage of women also receive a radial arterial graft, which may benefit female patients. A study at Washington University School of Medicine indicated that five-year survival was significantly better in 294 women who received a radial artery graft than in an equal number of women who did not.12

Washington University cardiac surgeons Jennifer Lawton, MD, and Ralph Damiano Jr., MD, both perform OPCAB surgery (the surgery is not appropriate for all patients) and give careful consideration to the bypass vessel used in CABG, depending on the age of the patient and other factors. Lawton also has contributed to the medical literature on women and heart disease and is sought as an expert in the field.

For more information:

Women and heart health web sources

References

  1. Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, Fabunmi RP, Kwan J, Mills T, Simpson SL. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005;111(4):499-510.
  2. Fisher LD, Kennedy JW, Davis KB, Maynard C, Fritz JK, Kaiser G, Myers WO. Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS). Journal of Thoracic and Cardiovascular Surgery. 1982;84(3):334-341.
  3. O'Connor GT, Morton JR, Diehl MJ, Olmstead EM, Coffin LH, Levy DG, Maloney CT, Plume SK, Nugent W, Malenka DJ, et al. Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. Circulation. 1993;88(5 Pt 1):2104-2110.
  4. Zitser-Gurevich Y, Simchen E, Galai N, Mandel M; ISCAB Consortium. Effect of perioperative complications on excess mortality among women after coronary artery bypass: the Israeli Coronary Artery Bypass Graft Study (ISCAB). Journal of Thoracic and Cardiovascular Surgery. 2002;123(3):517-524.
  5. Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Annals of Thoracic Surgery. 1998;66(1):125-131.
  6. Vaccarino V, Abramson JL, Veledar E, Weintraub WS. Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women. Circulation. 2002;105(10):1176-1181.
  7. Lawton JS, Brister SJ, Petro KR, Dullum M. Surgical revascularization in women: unique intraoperative factors and considerations. Journal of Thoracic and Cardiovascular Surgery. 2003;126(4):936-938.
  8. Petro KR, Dullum MK, Garcia JM, Pfister AJ, Qazi AG, Boyce SW, Bafi AS, Stamou SC, Corso PJ. Minimally invasive coronary revascularization in women: A safe approach for a high-risk group. Heart Surg Forum. 2000;3(1):41-46.
  9. Brown PP, Mack MJ, Simon AW, Battaglia S, Tarkington L, Horner S, Culler SD, Becker ER. Outcomes experience with off-pump coronary artery bypass surgery in women. Annals of Thoracic Surgery. 2002;74(6):2113-2119; discussion 2120.
  10. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. New England Journal of Medicine. 1986;314(1):1-6.
  11. Jacobs AK, Kelsey SF, Brooks MM, Faxon DP, Chaitman BR, Bittner V, Mock MB, Weiner BH, Dean L, Winston C, Drew L, Sopko G. Better outcome for women compared with men undergoing coronary revascularization: a report from the bypass angioplasty revascularization investigation (BARI). Circulation. 1998;98(13):1279-1285.
  12. Lawton JS, Barner HB, Bailey MS, Guthrie TJ, Moazami N, Pasque MK, Moon MR, Damiano RJ Jr. Radial artery grafts in women: utilization and results. Annals of Thoracic Surgery. 2005;80(2):559-563.