Heart disease is the number one cause of death in women in the United
States. Coronary artery disease — plaque building up in the arteries
supplying the heart muscle — is the most common type in both sexes, leading to
angina, heart attack, heart failure and arrhythmia.
The ten-year offset
**Before menopause, the body makes more oestrogen, which helps protect against
heart disease.** That is why **women generally develop coronary artery disease
about 10 years later than men**.
During and after menopause, oestrogen drops and risk rises. **Periods stopping
before 40 puts a woman's risk above others her age.**
The delay is protection, not immunity — and it ends.
Why diagnosis lags
Women are often not diagnosed as quickly as men, for three distinct
reasons:
- Women are more likely to have "silent" heart disease — no symptoms at
all. - Providers may not recognise it, because women's symptoms can differ
from men's. - **Women are more likely to have types of heart disease that are harder to
diagnose.**
And a delay in diagnosis is a delay in the care that prevents a heart attack.
The three types that affect women more
| Type | What it is |
|---|---|
| Coronary microvascular disease | Chest pain from spasms in the smallest arteries of the heart, pinching off blood flow — typically at rest or during routine activity. Serious, and harder to see on imaging, because the blockages are in small vessels |
| Broken heart syndrome | Strong chest pain that looks like a heart attack, caused by the stress of powerful emotions — grief, anger, surprise. It can happen in healthy people, mostly affects women after menopause, and usually causes no lasting damage |
| Variant angina | Rare; strong chest pain from spasms in the heart arteries, usually in a pattern during sleep. Rarely causes a heart attack |
Two of those three produce pain at rest or asleep — which is the opposite
of the classic exertional pattern people are taught to recognise, and part of
why reason 2 above happens.
What raises the risk
- Menopause, as above
- Family history — a mother or sister with heart disease before 65, or
a father or brother before 55 - Problems during pregnancy — high blood pressure, gestational diabetes,
anaemia - Hormonal birth control containing oestrogen and progesterone
- Endometriosis
Three of those five are specific to women and none of them appears on a
general heart disease risk list — which is the practical reason to know your
own.
Source: MedlinePlus, U.S. National Library of Medicine.
Licence: CC0 1.0 (public domain) · Adapted from medlineplus.gov
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