Recent science has shown us that heart disease doesn't always act the same in women as it does in men. The symptoms of heart attack are subtler for women—in fact, women may experience symptoms for days or weeks before the heart attack. They may also require different types of treatments. So what causes heart disease in women, and is it different from what causes heart disease in men?
Standard Risk Factors
The most common cause of heart disease in both men and women is atherosclerosis, or the narrowing and hardening of the arteries. Over time, cholesterol and other fatty deposits can build up in the arteries, creating a hardened plague that restricts blood flow, makes arteries less flexible, and increases the risk of a blood clot.
What causes atherosclerosis? Scientists aren't exactly sure why some people's arteries narrow enough to cause heart problems, while others may not. However, overall they agree that certain lifestyle habits increase risk of atherosclerosis in both men and women, such as:
- high blood pressure and high cholesterol
- family history of heart disease
- physical inactivity
Other Causes of Heart Disease
Besides atherosclerosis, there are several other potential causes of heart disease in both men and women.
Congenital Heart Disease
Women born with heart defects are at a higher risk of heart disease later in life. Heart defects can also develop in adults.
For one reason or another, the heart muscle becomes thickened or enlarged, and is less able to pump blood properly.
Certain bacteria, viruses, and parasites can infect the heart, causing heart disease.
Some antibiotics, over-the-counter medications, or even herbal remedies can sometimes lead to heart rhythm problems.
Illegal Drug Use
Drugs can cause a toxic reaction in the heart, leading to heart disease or heart attack. Needles used for injections can also transmit viruses and bacteria that may cause heart infections.
Many diseases can attack the heart valves (the "doors" that open and close within the heart itself to control blood flow), which can lead to heart failure.
Diabetes, lupus, rheumatoid arthritis, and other medical conditions can increase risk of heart disease.
Causes Specific to Women
Though most factors that cause or increase risk of heart disease are similar in both sexes, women may have different reactions to some.
Women are typically diagnosed with heart disease later than men. After menopause, estrogen levels in a woman’s body typically drop, leaving her more vulnerable to heart disease.
In a large meta-analysis of several studies involving almost four million people, researchers found that the risk for coronary heart disease was 25 percent higher in women who smoked than in men who smoked. Other research has shown that among smokers, women who had a heart attack were about two times as likely as men to suffer a complication such as a blocked artery within six months.
A study published in the Journal of the American College of Cardiology found that having symptoms of depression was associated with an increased risk of fatal coronary heart disease in relatively healthy women with no prior coronary heart disease. Depressive symptoms, especially antidepressant use, were also associated with sudden cardiac death.
In fact, depression has proved to be such a prominent risk factor for heart disease that the American Heart Association (AHA) has recommended that all cardiac patients be screened for the disorder. In addition, according to an analysis by researchers at Duke University, women with coronary artery disease are twice as likely to die if they exhibit symptoms of depression than women who don't.
According to research from the University of Cincinnati, bisphenol-A (BPA)—a chemical used in the manufacturing of plastics—may be harmful to the heart, particularly in women. Animal studies showed that BPA caused cellular changes in the female rodent heart, causing abnormal beating rhythms. The changes got worse when scientists added estrogen (the female hormone) to the mix.
According to a small 2011 study, HPV, the virus responsible for most types of cervical cancers, may also raise a woman's risk of heart attack and stroke. Researchers at the University of Texas found that women who tested positive for cancer-associated HPV infections had a greater prevalence of heart disease than uninfected women. These studies are preliminary, however, and additional research needs to be done.
Other Risk Factors
Scientists are still exploring the differences between heart disease in men and women, and are likely to learn more in the years to come. Some additional differences may include the ways in which fat is deposited in the arteries, as it appears to build up more evenly in women than in men. Women's heart disease may be more difficult to detect as a result. Women's arteries aren't as large as men's, even when adjusted for body size, so lesser amounts of plaque may restrict blood flow. Finally, artery problems in women seem to happen in the smaller, rather than the larger, blood vessels.
These differences mean that overall, heart disease can be much more subtle in women. Therefore, women need to be even more vigilant in taking care of themselves. This includes taking steps like stopping smoking, maintaining a healthy weight, and making regular doctor appointments to check up on blood pressure and cholesterol levels.