Women are not diagnosed or treated as aggressively as men. Even though more women than men die of heart disease each year, women receive only 33% of all angioplasties, stents and bypass surgeries; 28% of implantable defibrillators and 36% of open–heart surgeries, according to the National Coalition for Women with Heart Disease.

Although the traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — have a detrimental impact in men and women, certain factors play a bigger role in the development of heart disease in women.

• Metabolic syndrome — a combination of increased blood pressure, elevated blood glucose and triglycerides — has a greater impact on women than men. • Mental stress and depression affect women’s hearts more than they do men’s.

• Smoking is much worse for women than men.

• A low level of estrogen before menopause is a significant risk factor for developing microvascular disease.

• Though women will often have some chest pain or discomfort, it may not be the most prominent symptom. Diffuse plaques build–up and diseased smaller arteries are two reasons why symptoms can be different in women.

• In addition to chest pain, pressure or discomfort, signs and symptoms of heart attack in women include: Neck, shoulder, upper back or abdominal discomfort, shortness of breath, nausea or vomiting, sweating, light–headedness or dizziness and unusual fatigue.

• Endothelial dysfunction is more common in women. In this the lining of the artery does not expand (dilate) properly to boost blood flow during activity, which increases the risk of coronary artery spasm and sudden death.

• Results of the WISE study suggest that the commonly used treatments for coronary artery disease — angioplasty and stenting — are not the best options for women with more diffuse plaques.

• Typical tests for coronary artery disease — angiogram, treadmill testing and others — are not reliable in women.

• The WISE study showed that in some women, plaques accumulate as an evenly spread layer along artery walls, which is not visible using traditional testing methods.

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