Heart disease and heart attacks are often underestimated in women. (Image credit: eternalcreative/iStock via Getty Images)
A simple difference in genetic code—two X chromosomes versus one X and one Y—can lead to significant differences in cardiovascular disease. These genetic differences not only affect reproductive organs and the sex assigned at birth, but also dramatically alter the way cardiovascular disease develops and manifests itself.
Although sex influences the mechanisms by which cardiovascular disease develops, gender also plays a role in how health care providers recognize and treat these conditions. Sex encompasses biological aspects such as genetics, hormones, anatomy, and physiology, whereas gender refers to social, psychological, and cultural constructs. Women are more likely to die after a first heart attack or stroke than men. Women are also more likely to experience additional or unexpected heart attack symptoms beyond chest pain, such as nausea, jaw pain, dizziness, and fatigue. It is often difficult to completely disentangle the effects of sex on cardiovascular disease outcomes from the effects of gender.
Although women have a lower risk of cardiovascular disease than men before menopause, their risk increases significantly after menopause. Additionally, if a woman has type 2 diabetes, her risk of having a heart attack increases to the same level as men, even if she has not yet gone through menopause. More data are needed to better understand the differences in cardiovascular risk among non-binary and transgender people.
Despite these differences, one thing remains the same: heart attack, stroke, and other forms of cardiovascular disease are the leading causes of death among all people, regardless of sex or gender.
We are researchers studying women’s health and how cardiovascular disease develops and manifests differently in women and men. Our work highlights the urgent need to update health guidelines with more gender-specific approaches to diagnosis and treatment to improve health outcomes for all.
Gender differences in heart disease
The reasons for sex and gender differences in cardiovascular disease are not fully understood. Also, biological effects of sex, such as hormonal and genetic factors, are not clearly distinguished from gender effects, such as social, cultural and psychological aspects.
It’s well known that the available evidence about what quality heart care looks like for women versus men has as many holes as Swiss cheese. Scientific evidence about heart disease treatments often comes from studies that excluded women, because they were largely excluded from clinical trials until the NIH Revitalization Act of 1993. For example, current guidelines for treating heart disease risk factors like high blood pressure are largely based on data from men. This is despite evidence that differences in the development of heart disease mean that women experience heart disease differently.
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