Gender makes a difference in heart disease

by W. Gifford-Jones. M.D. and Diana Gifford-Jones
Common Sense Health

While the current pandemic holds a firm grip on everyone’s attention, another killer may be getting a stronger foothold on us – and chances are, women will continue to pay a higher price. Coronary heart disease is already a leading disease for women and men. Common sense suggests the situation is getting worse.

The sedentary lifestyle imposed by lockdowns, accompanied by weight gain and higher alcohol use, is not the way to lower incidence of heart disease. But how does it affect women differently?

A report in the journal, Circulation, notes that heart disease kills ten times as many women as breast cancer. It takes the life of one in every three women, more than all cancers, chronic respiratory diseases and accidents combined.

A report from the American Heart Association confirms stunning improvements in death rates of both sexes from coronary heart disease since 1980. But women have not shared the benefits equally.

One reason is that most people still tend to think of heart attack as a male disease. That’s largely because men suffer heart attack on average earlier in life, driving more attention. But in women, after menopause, the gender gap disappears.

What are the signs of trouble? Chest pain is the most common symptom in both sexes. But at least one-third of women do not show this classic symptom during coronary attack. Rather, they complain of shortness of breath, fatigue, nausea, palpitations, dizziness, intense anxiety or pain in the jaw, neck, upper back, or arm. These problems may be mistaken for a panic attack with fatal delay in diagnosis.

But suppose careful attentiveness leads to a rapid call to emergency? Even so, for women, studies show that an immediate electrocardiogram or stress test is less likely to show the typical finding of heart attack.

If a woman has an early diagnosis of coronary attack and survives it, a bypass operation may be required. Here, too, however, women still have twice the risk of dying during the surgery or shortly thereafter.

Tirone David, an internationally renowned heart surgeon in Toronto, explains one reason why the mortality rate is higher. The coronary arteries are smaller in females. This makes surgery technically more challenging when vessels the size of spaghetti are joined together.

What should women do to decrease the risk of heart disease? First, any woman still smoking should see a psychiatrist, as the risk of heart attack is seven times greater than non-smokers.

Knowing your family history is also key. If your father or brother had a heart attack before age 55, or your mother or sister before age 65, this substantially increases risk. It’s a red flag that urges “double down on preventive measures”.

If there is a history of cardiovascular disease, a daily 81 milligram Aspirin may be helpful. But since Aspirin can cause gastrointestinal bleeding, always discuss this medication with your doctor.

Remember that obesity leads to Type 2 diabetes, which in turn increases the risk of heart attack. Women who have trouble losing weight should try and try again.

Have your blood pressure checked. It has been estimated that one-third of heart attacks in women could be prevented by controlling blood pressure.

If blood cholesterol is elevated, cardiologists and most other doctors will recommend cholesterol-lowering drugs. Discuss this with your physician. But know there are alternatives, including high doses of vitamin C and lysine, a combination that has helped keep one of us alive for more than 20 years after severe heart attack.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at to receive our weekly e-newsletter. For comments,