Heart attacks are still often seen as a ‘male health’ issue, yet coronary heart disease – which is the main cause of heart attacks – is the biggest killer of women worldwide.

However, studies show women are more than 50 percent more likely than men to receive a misdiagnosis for a heart attack, and while chest pain is the most common symptom, women can have subtler symptoms.

How do heart attack symptoms differ in men and women?
“Most patients who have a heart attack get chest pain, however women are more likely to experience other symptoms, such as shortness of breath, nausea and vomiting, back pain, dizziness, light-headedness, upper back pressure or extreme fatigue,” says Professor Jamil Mayet, a leading cardiologist specialising in valvular heart disease, hypertension and sports cardiology for OneWelbeck.

“Having said that, traditional symptoms of a pressure or tightness coming and going in the centre of the chest lasting several minutes, discomfort in one or both arms and/or the jaw also commonly occur in women suffering a heart attack.”
Mayet says other signs, such as breaking out in a cold sweat, nausea or light-headedness, may also occur with the pain.

Are there other differences?
“Some of the tests used to assess the heart perform less well in women, and some of our treatments for the heart, such as coronary artery bypass grafting and coronary angioplasty and stenting, are less effective in women too,” says Mayet, who adds that this is likely because the coronary arteries in women are typically smaller than in men.

What age should women start monitoring their heart health?
Mayet says the fatty deposits that clog up our blood vessels, which can cause heart attacks and strokes, occur throughout our life. Early changes can even be seen in the vessels of teenagers.

“Ideally, we should be interested in our heart health throughout our lives, and make healthy choices as early as possible,” he stresses.

“Often good lifestyle habits slip when we start work and start families, because our time becomes more pressured – but that is a good time to take stock before bad habits get embedded.”

Our cardiovascular risk changes with time too, so there isn’t necessarily one single point to start taking it seriously – the earlier the better. However, Mayet adds: “In women, there is a step increase in cardiovascular risk at the menopause, and if there hasn’t been as assessment prior to that, this is a good time to start.”

Why is menopause relevant?
“Women’s hormones provide some protection from cardiovascular disease in the pre-menopause years,” says Mayet. “At the time of the menopause, this protection is lost and the cardiovascular risk rises, and continues to rise thereafter with age.

“However, the menopause itself doesn’t cause cardiovascular disease. There is some evidence that the oral contraceptive pill increases the risk of heart attacks, but it is typically used by young women whose baseline risk is usually very low, so this increase in risk is very small.”

It may still be possible to take measures to protect your heart health post-menopause though. Mayet says recent evidence shows that menopausal women taking HRT may have no higher risk of dying from a heart attack than women who don’t.

Does having children affect women’s heart health or risk of heart attacks?
Mayet says the heart can be affected during pregnancy – but generally speaking, there is no need for alarm. “Pregnancy increases the work that the heart has to do by about 50 percent. Occasionally, if there is a serious pre-existing heart condition, this can cause a problem.

“Very occasionally, pregnancy itself can cause heart disease and, in particular, weaken the heart muscle. However, this is rare and the vast majority of pregnancies do not cause any cardiac problems,” he assures.

“Its has been shown that the more children a woman has, the more likely she is to develop heart disease in later life, but it is still uncertain what the cause of this is.”

What changes in heart health and behaviour should women look out for?
“As we all get older, it is increasingly important to be aware of the risk factors that can affect our chances of developing cardiovascular disease,” says Mayet. “The more risk factors you have, the higher your chances of having a heart attack or a stroke. These include high blood pressure, a high cholesterol, smoking, diabetes, being overweight and not exercising enough.”

Do genes play a part?
Genetic factors also play a very important part in influencing your chances of developing heart disease. Being aware of a family history of things like high blood pressure and heart disease can be helpful.

“It’s been estimated that in some cases, this may double the risk,” notes Mayet. “Ethnicity also importantly influences the chance of developing heart disease. In particular, South Asian ethnicity strongly increases the chance of developing heart disease. African-Caribbean ethnicity is very strongly linked with high blood pressure and strokes.”

A family history does not mean you are destined to have heart disease – but Mayet says it does make it that bit more important to be aware and seek advice about looking after your heart and managing any increased risk. Healthy lifestyle measures are still very important.

What if you don’t know your family history?
If women can’t find out their family history, Mayet says they “should make sure they know what their blood pressure is, what their cholesterol level is, and should check that they don’t have diabetes”. Your GP or nurse can check all of these for you.

“In a lifestyle sense, you should avoid smoking, have a healthy diet and weight and exercise regularly,” adds Mayet.

A heart attack is a medical emergency, so you should always call 112 and ask for an ambulance if you suspect you or someone you know is having one. If you are concerned about your heart attack risk, speak to your GP for more information.