Women die more from cardiovascular diseases than men, and this is because they are protected by estrogen. But with the arrival of menopause and the drop in production of this hormone, the situation changes, especially with regard to heart attacks. And it does so in such a way that it is the first cause of death in women (in men, tumors). Women are twice as likely to die from an acute myocardial infarction, 18% compared to 9% of men.
Because? The Spanish Society of Cardiology (SEC) has studied it a lot. It is explained by factors such as the fact that women tend to develop coronary heart disease approximately 10 years later than men, so they tend to have more comorbidities (kidney disease, osteoarticular disease, hypertension, anemia…).
In addition, women tend to consult more late and, according to the research that has been carried out, receive less aggressive treatment than men. “For example, fewer catheterizations are performed on them than on men, partly because they arrive in a worse state, partly because they are older… But the reality is that there is undertreatment”, says Carolina Ortiz Cortés, coordinator of the project Woman and Heart of the SEC.
But why do they take longer to go to the doctor? Because a good part does not know the symptoms of the heart attack. Only 39% of women recognize them, according to the study Hombres y mujeres ante un IAM, ¿actuamos diferente? , presented at the Congress of the Spanish Society of Cardiology. The consequences of this lack of knowledge is that it takes 237 minutes to get to the emergency room from the onset of pain, while men only take 98 minutes.
And the remaining 61%? They simply believe they have digestive, respiratory, or some type of anxiety or depressive disorder.
Many women think that the symptoms of a heart attack are reduced to an oppressive pain in the center of the chest or in the epigastric (stomach) area, which can radiate to the left arm. But this is not the case or, rather, these symptoms do indicate a possible heart attack in both men and women, but others may appear in them, which few women relate to heart problems. (An understatement: chest pain lasting more than 15 minutes that reappears an hour later should alert us to seek immediate medical help, both in men and women).
The coordinator of the SEC’s Women and Heart project points out that the female group suffers more frequently from “nausea, vomiting and indigestion, and they also more often feel pain in the center of the back and in the jaw or neck. Also dizziness, tiredness, excessive sweating” ( See chart).
On the other hand, premenopausal women tend to present atypical symptoms more frequently than postmenopausal women, while older women may notice more sudden dyspnea (lack of air).
Carolina Ortiz indicates that women continue to think that heart attack is a men’s thing and this lack of knowledge explains that when they have symptoms they do not identify them and tend to think that it is a stomach problem or anxiety or something else. So they don’t go to the doctor, and this delay is fatal, he points out.
To this must be added the traditional role of the woman as caretaker of the rest of the family, which relegates her self-care. “This role of always looking at others means that she doesn’t look at herself, doesn’t stop to think about what’s happening to her, what her body is telling her”, points out the coordinator of the SEC’s Women and Heart project.
And as if that weren’t enough, the reality is that there are healthcare professionals who also don’t know how to recognize the “atypical symptoms” presented by women and tend to diagnose, for example, anxiety. It is necessary, Carolina Ortiz indicates, to increase the knowledge of both health professionals (“fundamental”, she explains) and women. This is also what Martha Gulati, a cardiologist at the Cedars-Sinai Heart Institute and a specialist in women’s cardiovascular health, refers to: are at risk of heart disease. As a result, the symptoms are often dismissed or, at the very least, not considered as possible heart diseases. It is a gender bias”, indicated the expert at the congress held by the SEC at the end of 2023.
In relation to the research, Gulati also remarked that for a long time women were not included in the clinical trials: “This has only aggravated the suboptimal treatment in them, because we are late to understand how the drugs affect them and therapies, for having left them out of the research. And to leave women out is to leave out 52% of the world’s population”.
In addition, women start to have symptoms even days before the dreaded heart attack arrives, but because it does not identify them, it takes much longer to enter the hospital. Then the prognosis is worse, because this vital muscle is already very impaired.
From the Working Group of Women in Cardiology of the SEC, they emphasize that there are two clear areas in which action must be taken to improve the cardiovascular health of women.
Firstly, through the knowledge and perception of the problem by the women themselves. At this point it is key to become aware of the role of hormonal changes during a woman’s life, as it has a considerable impact on cardiovascular health.
And they recommend a cardiovascular check-up at two times in a woman’s life: during pregnancy and postpartum, and in menopause, when cardiovascular risk factors such as hypertension, hypercholesterolemia or diabetes may appear, not previously detected and which women must be present, they explain from the SEC.
