It’s a stereotype that has been around for a long time: women’s hearts are more “fragile” than men’s. While the heart is often described as the seat of “emotions”, this cliché also implies that women are more emotional than men. But beyond the symbolism, the heart is above all the most important organ of the body, the engine of blood circulation.
Long considered “male” diseases, we now know that heart problems also affect women, and that certain cardiovascular diseases are almost essentially female. So, if we abandon the stereotypical field of emotions and focus specifically on health, can we say that women’s hearts are more fragile than men’s? What are the gender differences in cardiovascular health?
Canal Détox looked into the question.
Different anatomy and symptoms
From an anatomical point of view, there are differences between the hearts of men and women because on average, women have smaller hearts and finer arteries than men.
On the other hand, men and women are equal in terms of the prevalence of cardiovascular diseases. Cardiovascular diseases and their complications are the leading cause of death in the world, and are the second cause of death in France, after cancer, in both men and women (2022 data).
Over the past twenty years, however, we have observed a worrying increase in hospitalization rates for acute coronary syndrome.[1] particularly among women under 65 years of age. Several factors can explain this trend: an increase in exposure to well-known risk factors such as smoking, which is increasing significantly among women aged 35 to 64; the combination of tobacco and estrogen-progestin contraception; decreased physical activity and high sedentary lifestyle; alcohol consumption, or the increased prevalence of obesity and type 2 diabetes. The increasing hospitalization rate among women could also be due to greater awareness of the risk that they face cardiovascular diseases that have long been considered masculine.
However, it is especially when we look at the symptoms of cardiovascular accidents that the differences between men and women are most visible.
Let us return to the case of acute coronary syndrome. Studies highlight, for example, the additional risk for women of feeling pain between the shoulder blades, of having nausea or vomiting, and of shortness of breath. Unlike men, they would be less likely to feel chest pain or experience sweating.
In a review of the literature, the authors also raised the question of the inequality of categorization of women’s symptoms, presented in the context of acute coronary syndrome as “atypical” symptoms; while male symptoms are considered “typical”. 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, therefore, the delay in treatment which can penalize the prognosis.
Finally, we can also point out that women are more sensitive than men to the side effects of radiotherapy and chemotherapy. After having had cancer, particularly breast cancer, and after taking anticancer treatments, they have an increased risk of cardiovascular events. These data underline the importance of setting up a care pathway including cardiological monitoring of women after cancer treatment.
A cardiovascular risk that has been underestimated for many years
Until the end of the 1980s, few large clinical trials recruited women. This resulted in a lack of data to document the relationship between known risk factors and sex, but also a lack of communication from health professionals on the cardiovascular risks faced by women. The cardiovascular risk of women has therefore been underestimated for many years. This lack of data has also resulted, as mentioned above, in women’s less responsiveness to their body’s alerts.
Since then, guidelines have been launched to include more women in clinical trials[2]parity has not yet been achieved. A study published in 2020 in the Journal of American Heart Association, analyzing ten years of clinical trials did not show much improvement: clinical trials conducted between 2008 and 2017 revealed the participation of 36% women.
However, while cardiovascular diseases continue to represent a global public health scourge, it seems more essential than ever to better understand the specificities of these pathologies in women, to improve diagnosis and prevention, or even in order to adapt the treatments to their physiology.
Broken heart syndrome or takotsubo syndrome was first described in Japan in 1990. This heart failure occurs in the vast majority of cases after an intense emotional shock, leading to sudden weakness of the heart muscle after the massive release of stress hormones (from the catecholamine family: adrenaline, noradrenaline and dopamine which “constrict” the arteries of the heart which, suddenly deprived of a sufficient blood supply, sees its contractility severely altered). In 9 out of 10 cases, this condition affects women, and more specifically postmenopausal women. On the other hand, if women are indeed the main ones affected, men can also experience broken heart syndrome and the risk of death linked to the disease is also higher than in women.
Another example: SCAD (spontaneous coronary artery dissection), which particularly affects women, is a spontaneous tear in the walls of the coronary arteries, which can lead to a myocardial infarction. It mainly affects young women (also 9 out of 10 women), often in good health and without the usual cardiovascular risk factors.
Although these diseases are not exclusively female, they do depend on specific hormonal and physiological factors that increase the risk for women.
Until research knowledge progresses, prevention remains the best way to reduce cardiovascular risk in both women and men.
[2]For example, in 1993, the Food and Drug Administration (FDA) established guidelines aimed at increasing the diversity of participants in clinical trials.
Text written with the support of Nabila Bouatia-Naji, Inserm research director, head of the Genetic approaches to understanding arterial disease team at the Paris Cardiovascular Research Center (PARCC), unit 970; and Philippe Menasché, cardiac surgeon in the cardiovascular surgery department at the Georges-Pompidou European Hospital and researcher at PARCC
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