Heart Disease in Women: An Overlooked Epidemic
When we think of heart attacks on screen, iconic moments like Vito Corleone collapsing in The Godfather often come to mind – a dramatic, sudden event striking a middle-aged or older man. But in real life, heart disease isn't just a men's issue. It's also the leading cause of death for women, a fact often overlooked due to media stereotypes and gaps in medical research.
Despite this, many women remain unaware of their risk, and even when symptoms arise, they are frequently unrecognized or dismissed by healthcare providers. Women are more likely than men to have their heart-related symptoms misdiagnosed as anxiety or indigestion, leading to delayed treatment and worse outcomes. Research shows that women experiencing heart attacks are 50% more likely than men to be initially misdiagnosed, a gap that can have deadly consequences. Addressing these disparities requires a deeper understanding of how heart disease presents in women and a concerted effort to eliminate gender biases in diagnosis and care.
Historically, cardiovascular disease research and treatment guidelines have been based on studies conducted mostly on men, by men, leading to a widespread knowledge gap in how heart disease affects women. As a result, the medical system has often overlooked or misinterpreted women’s symptoms.
While men typically experience the "classic" heart attack symptom such as crushing chest pain, women are more likely to present with subtler signs such as shortness of breath, unusual fatigue, nausea, dizziness, or discomfort in the jaw, neck, back, or upper abdomen. These differences mean that women are more likely to be sent home from the emergency room without proper cardiac evaluation. Even when diagnosed, they receive less aggressive treatment. Studies show that women are less likely than men to receive procedures like angioplasty or coronary bypass surgery, even when they meet the same clinical criteria.
In addition to common risk factors like high blood pressure, high cholesterol, and smoking, women face unique biological and hormonal influences on heart health. Estrogen plays a protective role by helping blood vessels dilate and improving cholesterol balance, which is why heart disease risk rises significantly after menopause.
Pregnancy-related complications such as preeclampsia, gestational diabetes, and hypertension are also major red flags for future cardiovascular disease, yet many women are not informed of these long-term risks.
Autoimmune diseases like lupus and rheumatoid arthritis, both of which disproportionately affect women, also increase the likelihood of developing heart disease due to chronic inflammation.
Additionally, mental health plays a role, as depression, which affects women at higher rates, has been linked to increased cardiovascular strain.
Another underrecognized condition that disproportionately affects women is spontaneous coronary artery dissection (SCAD), a rare but serious cause of heart attacks that is frequently misdiagnosed.
Among women, Black women face an even greater burden when it comes to heart disease. They have the highest rates of high blood pressure, obesity, and diabetes, which are all major contributors to cardiovascular disease. Additionally, systemic healthcare disparities, socioeconomic barriers, and racial biases in medicine contribute to poorer outcomes.
Many Black women experience unique social stressors, including structural racism and chronic stress, which elevate inflammation and cardiovascular strain. Studies show that Black women are less likely to be referred for life-saving cardiac procedures and more likely to have their symptoms dismissed or misattributed to anxiety or non-cardiac conditions. Addressing these disparities requires systemic changes in healthcare delivery, along with increased awareness and advocacy for equitable treatment.
The under-recognition of heart attack symptoms in women is a serious issue that demands urgent action from both the medical community and society as a whole. Healthcare professionals need better training on the unique presentations of heart disease in women, and more research must be conducted to develop gender-specific treatment strategies.
In the meantime, women must become their own advocates in healthcare settings by speaking up about symptoms, seeking second opinions, and pushing for appropriate tests to ensure early and accurate diagnosis.
Increasing awareness through public health campaigns, community outreach, and patient education can also help close the gender gap in heart disease care.
As the leading cause of death for women, heart disease remains a significant but often overlooked threat, worsened by racial and socioeconomic disparities that prevent many from receiving life-saving treatment. By improving education, expanding access to equitable healthcare, and challenging biases in diagnosis and treatment, we can begin to change these statistics and ensure that all women receive the care they deserve.
