The media has typically portrayed cardiovascular disease (CVD) as a “man’s” disease and has clouded the importance and significance of CVD in women until now. CVD - including coronary heart disease, high blood pressure, and stroke - is now the leading cause of death among American women, and in 2013 CVD will account for 49.7% of all female deaths.6 Even a single risk factor at age 50 greatly raises the chance of heart disease or stroke and only about 10% of American women are free of these problems.7 In women versus men who have suffered heart attacks, the reports indicate 42% will die within one year opposed to 24% of men. Heart attacks in women under the age of 50 become twice as fatal as in men and women are more than twice as likely to die within a few weeks from the heart attack versus men.8 Approximately 46% of women who survive heart attacks become disabled by heart failure in six years,8 while 64% will die suddenly.9 Ischemic heart disease will account for 3.4 million and approximately 3 million women will die yearly from stroke and a remaining 2.2 million will die from hypertensive heart disease, rheumatic heart disease, and inflammatory heart disease.9
On a global scale, there are 26 million deaths in women each year, with 8.6 million resulting from CVD.10 Current trends indicate CVD and stroke, the first and second leading causes of death globally; will be responsible for increasing deaths and disabilities worldwide by 2020. The number of fatalities is expected to increase to 20 million yearly. By 2030, the rate is estimated to be 24 million.11
Fortunately, CVD is beginning to decrease in many developed countries due to factors such as public prevention programs and medical advances. However, the lower socioeconomic groups in developed countries have a greater prevalence of risk factors, higher incidence of disease, and higher rates of mortality exist. The rate is also increasing in many developing and transitional geographies (Figures 2‑3). It is estimated by 2040, women from Russia, Brazil, China, South Africa, and India will represent higher proportions in deaths from CVD than men.
From a historical perspective, CVD in men has overshadowed some gender differences related to its diagnosis, presentation, and treatment. Biologically, women have smaller hearts than men, making diagnosis and treatment more challenging.15 Women can present with subtle symptoms unrelated to those classic symptoms described by a man experiencing a heart attack. Unusual fatigue, indigestion, anxiety, shortness of breath, and sleep disturbance can be experienced. Men will typically describe chest pain as “crushing” rather than women referring to an “aching or squeezing.”16
Oftentimes these signs are associated with stress and panic disorders and, consequently, lead to a misdiagnosis and/or mistreatment of a potentially serious and deadly condition. Some treatments may be less aggressive for women due to their age, since heart disease is often diagnosed in their later years when estrogen production has diminished.16