Women die more from cardiovascular diseases than men, even though they are protected by estrogen. But, with the arrival of menopause and the drop in production of this hormone, the situation changes, especially with regard to heart attacks. And it does so in such a way that it is the first cause of death in them (in them, tumors). Women are twice as likely to die from an acute myocardial infarction, 18% compared to 9% for men.
Because? The Spanish Society of Cardiology (SEC) has carefully studied it. It is explained by factors such as the fact that women tend to present with coronary heart disease approximately 10 years later than men, which is why they tend to have greater comorbidities (kidney disease, hypertension, osteoarticular disease, anemia...).
Furthermore, women tend to consult more late and, according to research, receive less aggressive treatments than men. “For example, fewer catheterizations are performed on them, partly because they arrive in worse condition, partly because they are older...But the reality is that there is undertreatment,” says Carolina Ortiz Cortés, coordinator of the Women and Heart project. of the SEC.
But why do they take longer to go to the doctor? Because a good part is unaware of the symptoms of a heart attack. Only 39% of women recognize these symptoms, according to the study Men and women when faced with an AMI, do we act differently? , presented at the Congress of the Spanish Society of Cardiology. The consequences of this lack of knowledge is that it takes 237 minutes to arrive at the emergency room from the onset of pain, while men only take 98 minutes.
And the remaining 61%? He simply believes that he has digestive or respiratory problems or some type of anxiety-depressive disorder.
Many women believe that the symptoms of a heart attack are reduced to oppressive pain in the center of the chest or in the epigastric area (stomach), which can radiate to the left arm. But this is not the case or, rather, these symptoms do denote a possible heart attack in both men and women, but others may appear in them, which few relate to heart problems. (An aside: chest pain lasting more than 15 minutes that reappears within an hour should alert us to seek immediate medical help, in both men and women).
The coordinator of the Women and Heart project of the SEC points out that the female group suffers more frequently from “nausea, vomiting and indigestion, and they also more often report pain in the center of the back and in the jaw or neck. Also dizziness, tiredness, excessive sweating” (See graph).
On the other hand, premenopausal women tend to present atypical symptoms more frequently than postmenopausal women, while older women may report more sudden dyspnea (shortness of breath).
Carolina Ortiz indicates that women continue to think that heart attacks are a man's thing and this lack of knowledge explains that when they have symptoms they do not identify them and tend to think that it is a stomach problem or anxiety or something else. So they don't go to the doctor and that delay is fatal, she points out.
To this we must add the traditional role of women as caregivers of the rest of the family, which relegates their self-care. “This role of always looking at others means that she does not look at herself, she does not stop to think what is happening to her, what her body is telling her,” says the coordinator of the Women and Heart project of the SEC.
And if that were not enough, the reality is that there are health professionals who do not know how to recognize the “atypical symptoms” that women present, being inclined to diagnose, for example, anxiety. It is necessary, says Carolina Ortiz, to increase the knowledge of both health professionals (“fundamental”, she explains) and women.
This is also what Martha Gulati, the cardiologist at the Cedars-Sinai Heart Institute and a specialist in women's cardiovascular health, refers to: “There are biases in the care of women and, often, it is not considered that women are also at risk of suffer from heart disease. As a result, their symptoms are often dismissed or at least not considered possible heart disease. “This is a gender bias,” said the expert at the SEC Congress held at the end of 2023.
In relation to research, Gulati also highlighted that for a long time women were not included in clinical trials: “This has only aggravated the suboptimal treatment in them because we have been delayed in understanding how medications and therapies affect them. by leaving them out of the investigation. And leaving women out is leaving out 52% of the world's population.”
Furthermore, women begin to have symptoms even days before the dreaded heart attack arrives, but since they are not identified, it takes them much longer to be admitted to the hospital. By then, the prognosis is worse because this vital muscle is already very deteriorated.
The SEC's Women in Cardiology Working Group highlights that there are two clear areas in which action must be taken to improve women's cardiovascular health.
Firstly, through the knowledge and perception of the problem by the women themselves. At this point it is key to know the role of hormonal changes during a woman's life since it has a considerable impact on cardiovascular health.
And they recommend a cardiovascular check-up at two times in a woman's life: one, during pregnancy and in the postpartum and during menopause, a time when cardiovascular risk factors such as hypertension, hypercholesterolemia, diabetes, which were not previously detected and which may appear, may appear. Women themselves should know, the SEC explains.
