Heart Disease and Gender

Atherosclerosis

Factors That Influence Disease

Factors that influence disease: Atherosclerosis and gender

Atherosclerosis is often colloquially referred to as the 'hardening of the arteries.' In a patient with atherosclerosis, plaque builds up on the patient's blood vessels which are required to "carry oxygen-rich blood to your heart and other parts of your body" (What is atherosclerosis, 2013, NIH). Impeding this flow can have severe health effects, including coronary and cardioid heart disease as well as liver disease. "Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood" (What is atherosclerosis, 2013, NIH). If a piece of the plaque falls off or a blood clot forms on the plaque, the result can be a life-threatening heart attack or stroke. In some cases, the thinning of the artery walls causes angina or chest pain but in other instances there are no or very few symptoms.

Coronary heart disease is the number one killer of both men and women yet only recently has the condition in women received adequate attention. The 'classic' heart attack patient is often characterized in the popular cultural imagination as male even though men and women actually suffer from the condition in equal numbers. Women themselves often severely underestimate their risk, believing reproductive cancers to be more of a threat. Yet "nearly 500,000 women will die this year from cardiovascular disease, almost double the number of deaths caused by all types of cancer including breast cancer combined" (Ricciotti 2003).

Even healthcare providers may underestimate the risk posed to women. Women often experience different symptoms from men when suffering from atherosclerosis. Their symptoms can be more subtle and therefore are easily missed. While men are more likely to experience the classic 'elephant on the chest' feeling when experiencing an attack, women may think they have the flu. "Instead they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue" (Heart attack symptoms in women, 2014, AHA). Rather than pressure in the middle of the chest the pain may be somaticized as a sense of 'squeezing' in the back. Middle-aged and older women may also be apt to attribute these symptoms to menopause rather than heart disease. Women are assumed to be more likely to have psychosomatic disorders and the sensation that their heart is 'stopping' might be misattributed to anxiety rather than a physical condition (Ricciotti 2003). There is statistical evidence of this prejudice: more likely to be prescribed statins than women, despite the fact that the drugs are considered equally effective for both genders (Ricciotti 2003).

The risks which make one more prone to atherosclerosis are similar for women as they are for men: a poor diet, lack of exercise, and genetic susceptibility. But heart attacks are more deadly in women than men: a woman is 50% more likely to die during heart surgery than a man. This may be due to the greater 'subtlety' of signs that cause them to be missed, despite the fact that women are more likely to go to the doctor than men for regular check-ups. But it could also be due to "fundamental difference" in women's hearts vs. men's (Ricciotti 2003). Not only do "women have smaller hearts and smaller arteries than men" but there is evidence that "women also have a different intrinsic rhythmicity to the pacemaker of their hearts, which causes them to beat faster" (Ricciotti 2003). This means that a standard EKG may be less accurate for women than for men. "A 2000 article published in the New England Journal of Medicine reported that of 10,000 people who reported to a hospital emergency room, a small number had heart problems but were mistakenly sent home instead of being hospitalized. These people were more likely to be women under the age of 55, minorities, and people whose electrocardiogram (EKG) was normal" (Ricciotti 2003).