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. Heart disease is the leading cause of death for women in the United States, killing 299,578 women in 2017, or about 1 in every 5 female deaths.6 In 2017, CVD was the disease with the highest percent of total deaths for all subgroups of females.7 The reports indicate in those who have had a heart attack, 42% of women will die within one year opposed to 24% of men. Heart attacks in women under the age of 50 are 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
A global study reported that women are less likely to have heart disease and die of it, than men.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 sex and gender differences related to its diagnosis, presentation, and treatment. Biologically, women have smaller hearts than men, making diagnosis and treatment more challenging.15 Symptoms of a heart attack can be very different between individuals, but especially for men and women. The most common signs of a heart attack are the same for both, such as shortness of breath, sweating, pain in the chest, neck, or arms. Women can present with additional subtle symptoms unrelated to those classic symptoms, such as unusual fatigue, nausea, anxiety, uncomfortable pain between the shoulder blades, and sleep disturbance. 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