More than 60 million US women (or 44%) have some type of heart disease. It’s also their number one cause of death in America, responsible for the death of one in five women every year.
And yet, women experience far worse heart health outcomes than their male counterparts. Even when speaking to a doctor, they’re often underdiagnosed.
To understand why, we need to look closer at some outdated guidelines that don’t account for differences between the male and female sexes.
3 reasons why women see poorer heart health outcomes (and what they need to know)
We already know there are heart disease differences between men and women. Unfortunately, many of these are underconsidered or poorly factored into official diagnoses.
There are, in my opinion, three major reasons why.
1. Shifting sex hormones
Women typically have higher levels of estrogen and progesterone than men, which are thought to help prevent the risks of heart disease. Interestingly, research shows that cardiovascular risk accelerates after menopause. Plus, with women entering puberty earlier, menopause tends to occur much earlier.
This tells us two things. One, that women’s heart health is closely tied to hormones. Two, that disrupted hormones (and earlier puberty dates) mean women are more at risk earlier in their lives.
But apart from menopause, there are other factors unique to women that may accelerate risks for heart disease. This includes:
- Preeclampsia
- Eclampsia
- Gestational diabetes
- Birth control pills, which can increase blood clot risks
Unfortunately, many doctors are unfamiliar with the unique effects of women’s hormones on heart health. It comes as no surprise that many don’t inform women of their risks earlier in life. Of the 74% of women who display the risk factors for heart disease, just 16% are told by their doctors that they have any sort of cardiac risk.
2. The age misconception
Since estrogen and progesterone may protect the heart against disease risks, some people (and medical professionals) have the belief that women are “protected” against cardiovascular disease until much later in life.
However, while heart attacks as a whole are dropping in the US, the number is rising for women between 35 and 54. And no wonder. When younger women display the signs and symptoms of heart disease, doctors may assume they’re pointing to something else. And these women, who may be completely unaware of their own risks, may not have the knowledge to advocate for themselves.
The truth is that women can experience heart disease in their 50s and younger. I can vouch for this with personal experience, as many of my patients are in their 50s nowadays.
So asserting that “women are immune to heart disease” until an arbitrary age simply creates a false sense of security.
3. Differences in biomarkers
Some biomarkers remain the same between the sexes. For example, blood pressure below 130/85, or blood sugar below 100 40 mg/dL.
But in a study exploring sex differences in cardiovascular disease, 86% of 71 biomarkers examined differed between men and women. Most of these biomarkers (37 to be specific) were higher in biological women than in biological men.
The reasons for this are, unfortunately, unclear. We have quite a lot of work to do researching the gender gap in developing heart disease. But existing research still brings up a very important point: just because you fall within a ‘reference range’ doesn’t mean you’re safe from heart disease.
A great example of this is hypertrophic cardiomyopathy (HCM), which refers to a condition where a thickened heart prevents blood from pumping efficiently. It’s relatively common, affecting one in 500 people, and may cause heart attack and death in the most severe cases.
But while two in three people diagnosed with HCM are men, researchers posited that women are just as likely to suffer from this condition. So experts employed an alternative method of HCM diagnosis that accounted for age, sex, and size rather than the traditional “15mm thickness” guideline. It also accounted for unique female-specific factors: women’s hearts are roughly two-thirds the size of men’s, and they have smaller arteries and faster heart rates.
Not only was this new method of testing for HCM far more efficient, but in a test of 43,000 people, the “sex skew” reduced the diagnoses of men from 89% to 56%, meaning that a whopping 44% of the participants diagnosed with HCM were women. Put another way, thousands of women otherwise would have gone under- or misdiagnosed using traditional heart health guidelines.
The good news is, you can start on your own. If you’re a woman wanting to measure your metabolic health at home, you may need to adjust the following biomarkers:
- HDL cholesterol over 50 mg/dL. Men’s HDL cholesterol should be over 40 mg/dL.
- A waist circumference of less than 35 inches. For men, it should be less than 40 inches.
- Higher levels of adipokines and inflammatory markers, including leptin and CRP.
You can learn more about specific labs in my guide to the biomarkers you’re not checking for metabolic syndrome.
How women can take control of their metabolic health
Sex-specific heart health care clearly has a long way to go. But with a newfound interest in metabolic health, I’m hopeful the guidelines will begin to change.
Of course, waiting for the world to “catch up” with sex-specific heart health care will take some time, likely longer than most of us can afford. To the woman reading this: no one will care as much about your metabolic health — and consequently your heart health — as much as you do.
That’s why I heavily suggest you:
- Get a doctor who ‘gets it’. The goal is to find a healthcare professional who’s curious, open to conversation, and proactively doing research of their own. You should also find a physician experienced in sex-specific heart health. Case in point: 78% of PCPs and 58% of cardiologists do not feel “extremely well prepared to assess cardiovascular risks in women.” Yes, this may require you to fire your existing doctor. But I promise your heart health is more than worth it.
- Do more of your own research. I want you to be educated so you can make informed decisions for your own health. Thankfully, there are plenty of resources available online, including new research to further the conversation.
- Benchmark your metabolic health. That way, you have a better idea of how healthy your heart is. And yes, lab work and blood draws should have a place in this. But you can always start simple with my free metabolic health quiz here.
