Heart attack or myocardial infarction (MI) is the leading cause of death globally.

In the United States alone, 1 in every 4 deaths is due to heart disease, and around 750,000 Americans have a heart attack each year, with women accounting for over half of these cases. However, the risk factors, symptoms, diagnosis, and treatment are often different in men and women, creating a paradoxical risk of heart attack for women.

What is Heart Attack and How Does it Happen?

A heart attack occurs when the blood supply to the heart muscle is blocked and the heart cannot get enough oxygen to meet its needs.

This usually happens when a clot forms in a coronary artery that supplies blood to the heart muscle, either because of atherosclerosis (plaque buildup) or a rupture of a plaque. The lack of oxygen-rich blood can damage or destroy part of the heart muscle, leading to chest pain or discomfort (angina), shortness of breath, fatigue, nausea, vomiting, sweating, and other symptoms.

What are the Risk Factors for Heart Attack in Women?

While the traditional risk factors for heart attack, such as high blood pressure, high cholesterol, smoking, diabetes, obesity, physical inactivity, and family history, apply to both men and women, there are some additional risk factors that are more common in women. These include:.

Age: Women over 55 are at a higher risk of heart attack than men of the same age, partly because of decreased estrogen levels after menopause.
Gender: Women are twice as likely to die within a month of having a heart attack than men, partly because they are less likely to get timely and adequate medical care.
Pregnancy complications: Women who had preeclampsia, gestational diabetes, preterm birth, or low birth weight babies are at a higher risk of heart attack later in life.
Autoimmune diseases: Women with rheumatoid arthritis, lupus, or other autoimmune diseases are at a higher risk of heart attack, partly because of chronic inflammation.
Psychological stress: Women who experience chronic stress, depression, anxiety, or trauma are at a higher risk of heart attack, partly because of altered blood vessel function and hormonal balance.

Why is Heart Attack Often Misdiagnosed or Delayed in Women?

One of the paradoxes of heart attack in women is that they are often misdiagnosed or delayed in receiving the appropriate treatment, partly because of the following reasons:.

Atypical symptoms: Women are more likely to have atypical or subtle symptoms of heart attack, such as nausea, abdominal pain, back pain, or jaw pain, which can be mistaken for other conditions, such as indigestion, acid reflux, or flu.
Delayed seeking of care: Women may delay seeking medical care for their heart attack symptoms, partly because they are more likely to downplay or ignore their symptoms, or to prioritize their caregiving duties or work responsibilities.
Gender bias: Women are less likely to be referred for diagnostic tests, such as electrocardiograms (ECG), stress tests, or angiograms, or to receive standard treatments for heart attack, such as aspirin, nitroglycerin, or reperfusion therapy, which can restore blood flow to the heart. This can be partly because of gender bias among healthcare providers, who may perceive women as less likely to have cardiovascular disease and less likely to benefit from aggressive interventions.
Comorbidities: Women are more likely than men to have other health conditions, such as breast cancer, osteoporosis, or chronic kidney disease, which can complicate the diagnosis and treatment of heart attack.

How Can Women Reduce their Risk of Heart Attack?

The good news is that heart attack is largely preventable, and women can take several steps to reduce their risk, such as:.

Know your risk: Women should know their personal and family history of heart disease, and get regular check-ups to monitor their blood pressure, cholesterol, blood sugar, and other risk factors.
Adopt a healthy lifestyle: Women should follow a heart-healthy diet that is rich in fruits, vegetables, whole grains, lean proteins, and low in saturated and trans fats, sodium, and added sugars. They should also maintain a healthy weight, exercise regularly, avoid smoking and exposure to secondhand smoke, and limit alcohol intake.
Manage stress: Women should strive to manage their stress through stress-reducing techniques, such as meditation, yoga, deep breathing, or counseling. They should also seek social support from family, friends, or support groups, and prioritize self-care and relaxation.
Take medications as prescribed: Women who have high blood pressure, high cholesterol, diabetes, or other conditions that increase their risk of heart attack should take their medications as prescribed by their healthcare provider, and attend regular follow-up visits to monitor their progress.

Conclusion

Heart attack is a major health concern for women, but it is often paradoxical because of the differences in risk factors, symptoms, diagnosis, and treatment between men and women.

Women should be aware of their risk factors, adopt a healthy lifestyle, manage their stress, and seek timely medical care for any symptoms of heart attack. Healthcare providers should also be aware of the gender bias and atypical symptoms of heart attack in women, and provide equitable and evidence-based care to reduce the mortality and morbidity associated with heart disease.