Myocardial infarction, commonly known as a heart attack, is a type of ischemic heart disease that can affect people in their prime of physical, mental, and reproductive health, decreasing their work efficiency. It is also the leading cause of death, even in women. Coronary heart disease, a type of heart disease, affects 1 in 9 women between the ages of 45 and 64 and 1 in 3 women after the age of 65. The risk of death due to coronary heart disease is far greater than that of breast cancer, at a rate of 31 percent.

Cardiovascular Risk Factors

The nonmodifiable cardiovascular risk factors are:

  • Age
  • Familiarity
  • Gender
  • Ethnicity

Conversely, cardiovascular risk factors that can be modified by lifestyle are:

  • Smoking
  • High blood pressure
  • Diabetes
  • Dyslipidemia
  • Overweight
  • Stress
  • Sedentariness

The most common coronary risk factors in women are hypertension, diabetes mellitus, and smoking. About 50 percent of women over the age of 45 have hypertension, and about 40 percent of women over the age of 55 have elevated blood cholesterol levels. In recent years, women have not reduced their smoking habit, unlike men who smoke less. Notably, women also have a greater vulnerability to smoking, and thus, it is enough for them to smoke one-third as many cigarettes as men to have the same level of risk.

About 25 percent of women do not exercise regularly, and the prevalence of obesity is increasing. Diabetes remains a significant risk factor for cardiovascular disease in women because it increases the chance of having coronary artery disease by 3 to 7 times.

Menopause: The Ultimate Female Risk Factor

It is essential to specify that in female existence, there is a natural watershed constituted by menopause, an all-female risk factor that causes a series of hormonal changes. Following a reduction of estrogen in the blood, cholesterol levels tend to increase during menopause: more precisely, there is an increase in LDL (the cholesterol defined as bad), a reduction in HDL (the cholesterol defined as good), and an increase in triglycerides.

Blood pressure values tend to register an elevation linked to an increase in weight, leading to hypertension, the most crucial relative risk factor.

Thus, the critical age in women is about ten years later than in men, between 65-80 years, resulting in older and more frail patients who are more likely to have other conditions that may make the initial diagnosis of heart disease more difficult and affect cardioactive therapy.

Then there are some lesser-known risk factors represented by autoimmune diseases, such as lupus and rheumatoid arthritis, and chronic inflammatory diseases in general, which predominantly affect women, associated with higher cardiovascular risk because a chronic inflammatory state seems to be the culprit for an early and accelerated atherosclerotic process.

In addition to the listed risk factors, there is an additional one in women, represented by their different perception towards their health and, consequently, towards the disease state, with a different conception of cardiovascular disease than men. More than one in three women do not know, for example, that they have high blood pressure, and 40 percent do not think they have high blood cholesterol levels.

Hence, there is also a need for more attention to primary prevention by most women themselves.

Symptoms of Heart Attack in Women

Heart disease is a leading cause of death in women, and the symptoms of heart attack can be different in women than in men. Here are the most common symptoms of heart attack in women:

  • Difficulty breathing: Women may experience shortness of breath for no apparent reason, even if they have not been exercising. Suddenly, simple tasks become tiring.
  • Chest, neck, and shoulder pain: The pain is less oppressive and tends to radiate to the back, which can be mistaken for back pain and neglected until other signs appear. The pain may also travel up to the neck and shoulders, in addition to being localized in the chest. In some cases, the discomfort may also move to the stomach, which can be confused with gastroesophageal reflux or gastritis.
  • Severe nausea: Severe nausea, accompanied by profuse and cold sweating and dizziness, can be a sign of coronary artery disease.
  • Extreme fatigue: Extreme fatigue is a common heart attack symptom in women.

It is important to note that women with cardiovascular disease are often older, hypertensive, diabetic, and dyslipidemic. Therapy should aim to correct risk factors, and care should be calibrated to the specific hormonal and body mass differences in women. Gender medicine is an emerging field that recognizes these differences.

Studies show that women with ischemic heart disease are less likely to undergo necessary procedures and receive appropriate medication, leading to worse outcomes compared to men. Therefore, it is crucial to assess individual cardiovascular risk and implement primary prevention measures before the onset of heart disease.

In summary, recognizing the symptoms of heart attack in women is crucial to prevent adverse outcomes. It is essential to consider the unique needs of women when providing cardiovascular care and treatment.