A gender-based guide to better heart health

When it comes to the number one health problem in the United States—heart disease—do men and women need separate health advice? The answer is yes ... and no.

Regardless of gender, heart disease occurs when the heart has been weakened over time by an underlying problem, such as clogged arteries, high blood pressure, or a defect in the heart muscle walls. But that's really where the similarity ends. Although heart disease is a fairly equal-opportunity problem, heart attacks are not. Women who have heart attacks are twice as likely to die as men.

The heart attack gender gap has multiple causes. One factor might be that physicians and researchers have traditionally viewed heart attacks as a male problem, so diagnosis and treatment protocols have been designed with that gender bias in mind. The problem isn't just in the medical community. Women often ignore or don't recognize signs of an impending heart attack, because they don't realize they are susceptible or because their symptoms can be quite different from the classic heart attack symptoms.

Chest pain, the classic symptom most men experience, is often absent or felt differently by women. The symptoms women are likely to experience preceding a heart attack—unusual fatigue, sleep disturbances, shortness of breath, indigestion, anxiety, feeling sad—are often dismissed by women or misdiagnosed by their physicians.

Although risk factors are similar for men and women, there are subtle differences.

Hormones play a role in risk. Women tend to have heart attacks later in life because of the protective role of estrogen. Early menopause—whether natural or surgical—is a risk factor for women. For men, testosterone may raise the level of low-density lipoprotein, which, in turn, increases the risk of heart disease.

Elevated cholesterol is a risk factor shared by the sexes, but there are some subtle differences to consider there as well.

A high total cholesterol concentration has long been a red flag for potential heart problems. But for women, total cholesterol is not as strong an indicator of heart disease as it is for men. The high-density lipoprotein concentration appears to be a more significant factor for women—an important piece of information for women and their physicians. National guidelines define an HDL concentration less than 35 mg/dL as a risk. That is appropriate for men, but for women, the value needs to be pegged higher. An HDL concentration of 45 mg/dL should be considered the minimum.

Smoking is a major heart disease risk factor, as most everyone knows. What may not be as widely known, however, is that studies suggest women's hearts are damaged more severely by smoking. As a consequence, female smokers who suffer heart attacks do so, on average, eight years earlier than male smokers.

Diabetes, another cardiovascular disease risk, seems to affect women differently than men, posing a higher risk for a heart attack.

Unfortunately, what happens in the doctor's office may pose an additional risk for women. While physicians may routinely screen their male patients for heart disease and related risk factors, women don't always receive the same kind of attention. Both men and women should discuss heart health with their physicians. Women may have to look a little longer and harder to find a physician who is comfortable with, and capable of, dealing with women-specific heart care.

On the other hand, many men don't get to the doctor's office regularly or at all. Some men put themselves at risk by trying to "tough out" symptoms, or simply by not getting regular medical care.

When it comes to prevention, the basic heart-health tips work equally well for men and women. Don't smoke. Maintain a healthy weight, with a diet that's low in saturated fats. Exercise. Maintain a healthy blood pressure. Prevent or control diabetes.

Besides striving to put these health tips into action in daily life, one can gain an even better edge on heart health by keeping in mind the subtle, gender-specific risks.