Before menopause, according to the Fondation Agir pour le coeur des femmes, “the large coronary arteries present soft, poorly calcified atherosclerotic plaques that tear and stick back together, which causes fluctuating symptoms, such as palpitations, shortness of breath or digestive pain. In addition, “these clots can break away and further block the small arterioles inside the heart muscle, thus damaging the heart slowly.”
Different symptoms
As Inserm explains, it is when we look at the symptoms of cardiovascular accidents that the differences between women and men are even more visible. Example with acute coronary syndrome. According to several studies, women are less likely to experience chest pain or sweating but, conversely, more pain between the shoulder blades, shortness of breath, nausea or vomiting.
In addition, after menopause, the damage to the microcirculation, mentioned above, worsens with age, hypertension or excess cholesterol. The arterioles thicken and become blocked, the heart tires, which can lead to heart failure. “This distal arteriolar disease explains the atypical presentation of myocardial infarction, despite the absence of occlusion of the large coronaries. These lesions are not visible on coronary angiography, an examination which only reveals lesions of the large coronary arteries. Detectable with special examinations, this arteriole disease is nevertheless associated, according to the Fondation Agir pour le coeur des femmes, with a mortality risk as high as the more classic disease of the large coronary arteries.
-‘Atypical’. Here is a word that calls out. A meta-analysis showed that women’s symptoms of acute coronary syndrome were presented as atypical in the literature, even though this potentially affects half of the world’s population! “This symptomatology, considered atypical, combined with the greater ability of women on average to ignore pain, partly explains the often late nature of the consultation and, as a result, the delay in treatment which can penalize the prognosis,” underlines Inserm.
Different risk factors
Women may also be more sensitive than men to the side effects of radiotherapy and chemotherapy. Thus, after anticancer treatments, they present an increased risk of cardiovascular accident. According to the CWHHC, if the risk factors are the same in men as in women, they are associated with a greater cardiovascular risk in women. Diabetes, being overweight, physical inactivity, smoking, physical inactivity, hypertension and family history “should ring alarm bells because they are associated with a higher degree of risk in women.”
