Heart-to-heart: gender differences in cardiac care

For quite some time it was assumed that the male and female heart functioned in essentially the same way. But as science advances, it’s become clearer that there are gender differences in how hearts grow, and how diseases develop and manifest.

“While most risk factors for heart disease affect both genders, some more actively promote disease in women,” says Karol Watson, MD, director of the UCLA Women’s Cardiovascular Center. “Risk factors such as insulin resistance, being overweight or obese, and having high triglycerides tend to be more harmful in women.”

Analyzing gender differences in aging hearts

A federally funded study analyzed MRI scans of aging hearts as part of an ongoing, long-term project called the Multi-Ethnic Study of Atherosclerosis (MESA), which is following thousands of men and women of different ethnic backgrounds across the country. Several institutions, including UCLA, were involved in the MRI study.

Researchers studied scans of nearly 3,000 older adults, ages 54 to 94, without preexisting heart disease. Participants were tracked between 2002 and 2012. Each participant underwent MRI testing at the beginning of the study and once more after a decade.

The MRI scans revealed significant differences in the way male and female hearts change with age. The research was published online in the October 2014 edition of the journal Radiology. The results don’t explain why there are gender differences. It does, however, shed light on the different forms of heart failure seen in men and women. Those differences indicate that there may be a need to develop gender-specific treatments. The standard practice has been to develop both diagnostics and treatments based on the male heart. With this study and others that approach is changing.

Heart failure: similarities and differences

In both genders, the main heart chamber, the left ventricle–which fills with and then forces out blood–gets smaller with age. As a result, less blood enters the heart and less gets pumped out to the rest of the body. But in men, the heart muscle that encircles the chamber grows bigger and thicker with age, while in women, it retains its size or gets somewhat smaller.

According to the researchers, a thicker heart muscle and smaller heart chamber volume may increase the risk of age-related heart failure. The gender variations suggest that men and women may develop the disease for different reasons.

A condition that affects more than five million Americans, heart failure is a gradual weakening of the heart muscle and eventual loss of pumping ability. To lower the risk, cardiologists often prescribe medications designed to reduce the thickness of the heart muscle and boost cardiovascular performance. But because a woman’s heart muscle tends to shrink or remain the same size suggests that women may not derive the same benefit from such treatments.

Compared to men, women with heart failure also tend to have more symptoms such as shortness of breath and more difficulty exercising. They also have swelling around their ankles more frequently than men. Despite those differences, however, women generally survive longer than men with heart failure.

Heart attack symptoms vary

Men and women can experience heart attack very differently, according to Dr. Watson.

“For men, it’s a like bomb going off–you get a dramatic chest pain that sends you to your knees. But for women, the symptoms can be more subtle.”

Women may experience jaw or arm pain, feel nauseated or very tired. Because of that, women’s heart attacks often go unnoticed. If heart attack is suspected, call 9-1-1 immediately. Heart attacks occur because the blood supply to the heart has been cut off, most often due to blocked coronary arteries. About 70 percent of men and women in the 60-to-79-year-old age group has cardiovascular disease. Age is a factor, but you can take preventative steps to reduce heart disease risk. A heart-healthy diet as well as physical activity that includes muscle building and cardiovascular exercises will benefit your heart. The American Heart Association also recommends an ankle-brachial index test for everyone over the age of 60. It’s a simple in-office test. Using the blood pressure cuff, your health care provider measures and compares the systolic pressure in your arms and legs. The test helps diagnosis the presence of peripheral artery disease (PAD), a type of cardiovascular disease where plaque builds up in arteries of the legs.

WHAT YOU SHOULD KNOW

Men’s and women’s hearts age differently.

  • Heart attack symptoms in men are more dramatic and more subtle in women.
  • Insulin resistance and high triglycerides appear to be more harmful to women’s hearts.
  • Women tend to develop heart failure at an older age than men.
  • Aspirin may be beneficial in preventing heart attack and stroke
  • Regular exercise and a heart-healthy diet is beneficial to everyone

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