Cardiovascular Diseases In Women: An Underestimated Risk
In March, we are focusing on women's heart health. We provide information about risks, warning signs and preventive measures so that you can protect your heart in the best possible way. Warning signs are often not recognized in time, as symptoms can be different in women than in men. Read more in the following article!
Cardiovascular disease is the most common cause of death among women in Germany (1), yet the risk is often underestimated. Decades of research gaps and gender bias in medicine, as well as the gender health gap (2), have led to less knowledge and research into the symptoms and risk factors in women. While men and women are equally affected by heart disease, there are significant differences in symptoms, diagnosis and treatment. This describes the differences in medical care and research between men and women. For example, women are less likely to be included in clinical studies (gender data gap) than men, which means that many drugs are mainly tailored to the male body or that typical female diseases are often diagnosed later or taken less seriously. This makes a decisive difference, particularly in the case of cardiovascular diseases.
To what extent is heart health assessed differently in women?
For a long time, cardiology studies were mainly carried out on men. As a result, typical symptoms of a heart attack - such as severe chest pain - were considered standard. Women, however, often show non-specific signs that are not immediately associated with heart disease. Instead of a pressing pain in the chest, many women report diffuse symptoms that initially resemble stomach problems or exhaustion. As a result, heart attacks in women are often not recognized until later, which can significantly worsen the prognosis. This is precisely where gender-sensitive personalized medicine (GSM+) comes in. In addition to gender, it also takes into account age, physical and psychological characteristics, as well as socio-cultural differences such as origin, religion and sexual orientation. Organizations such as the German Society for Gender-Specific Medicine promote their consideration in research and practice.
Specific symptoms in women include:
Shortness of breath
Nausea and vomiting
Back pain
Pain in the upper abdomen
Extreme tiredness
What symptoms do women need to be particularly aware of?
Hormonal influences, such as the drop in oestrogen during the menopause, lead to a higher risk of cardiovascular disease. Oestrogen has a protective effect on the blood vessels, so a drop in hormone levels can have a negative impact on overall health. Women who have experienced more serious pregnancy complications during one or more pregnancies - such as pre-eclampsia (pregnancy poisoning) or gestational diabetes - also have a higher long-term risk of high blood pressure and heart attacks. Autoimmune diseases such as lupus or rheumatoid arthritis are more common among women than men - these can put a strain on the cardiovascular system (3). Last but not least, psychosocial factors such as chronic stress, depression and a high level of psychological stress also have a greater impact on women's heart health than men. Other symptoms that women should pay particular attention to are shortness of breath, nausea and vomiting, back pain, pain in the upper abdomen and extreme tiredness. These differences illustrate how important it is to focus more on gender-specific symptoms in cardiology care.
In addition, there are conditions that are not primarily associated with the heart but nevertheless have a significant impact on vascular health. Pregnancy complications such as pre-eclampsia or gestational diabetes are far more than temporary health problems - they can increase the risk of high blood pressure and coronary heart disease in the long term. Autoimmune diseases, which are more common in women, also have an effect on the cardiovascular system that should not be underestimated. Psychosocial factors also play a key role: stress, depression and high levels of emotional stress are often more pronounced in women and can have a negative impact on the heart.
The situation is different for men: a heart attack usually manifests itself in men with typical and clear symptoms. They often feel a sudden, severe pain or a pressing tightness in the chest, which is often described as a burning sensation or heavy weight. This pain can radiate to the left arm, shoulder, jaw or back. It is often accompanied by shortness of breath, profuse sweating with cold sweats, dizziness or light-headedness. Many sufferers feel extremely weak or have a strong feeling of anxiety, which is often described as "fear of death". In some cases, nausea or vomiting may also occur, although these symptoms are less common in men than in women. As these signs should be taken very seriously, if a heart attack is suspected, call 112 immediately to ensure rapid medical treatment.
Prevention and early detection: what women can do - at any age
A healthy lifestyle and regular check-ups play a key role in reducing the risk of cardiovascular disease. Women should make sure they remain physically active and get at least 150 minutes of moderate exercise per week. A balanced diet is also essential - the Mediterranean diet with lots of vegetables, healthy fats and little sugar has proven to be particularly heart-friendly. In addition to diet and exercise, stress management also plays a major role. Chronic stress can put a strain on the cardiovascular system and increase the risk of high blood pressure and other illnesses. Techniques such as meditation, breathing exercises or a conscious work-life balance can help to make everyday life more relaxed. In addition, women should have their blood pressure and cholesterol levels checked regularly, especially after the menopause, as the risk of heart disease then increases.
Women's heart health needs more attention - both in research and in clinical practice. A gender-specific approach to prevention, diagnosis and treatment is crucial to detect and prevent cardiovascular disease in women at an early stage.
Sources:
(1) Federal Statistical Office DESTATIS, accessed February 26, 2025 https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Todesursachen/_inhalt.html
(2) World Economic Forum, accessed February 22, 2025 https://www.weforum.org/stories/2024/01/women-health-davos-2024/
(3) Spectrum, accessed February 22, 2025 https://www.spektrum.de/news/warum-autoimmunkrankheiten-vor-allem-frauen-treffen/1984777
(4) Ärzteblatt, as of February 25, 2025 https://www.aerzteblatt.de/archiv/postmenopausale-frauen-kardiovaskulaere-protektion-durch-oestrogen-gestagen-substitution-8dc96df4-3e90-4388-88e4-54453fba9f99