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It may seem as if heart disease affects mostly men, but in fact it’s the No. 1 cause of death for both genders—more people die from heart disease than all cancers combined. Perhaps even more surprising is that more women than men will develop heart failure or die within a year of a heart attack.

Medical professionals don’t completely understand why women have worse outcomes than men when it comes to heart disease. One factor, however, is that heart attack symptoms are often very different in women and in some cases aren’t as obvious. Like men, women may experience classic chest pain, but they may also have a variety of more general symptoms, including:

• nausea or vomiting,
• indigestion,
• shortness of breath,
• pain in the upper back or arm,
• neck and jaw pain, or
• unusual fatigue.

Sometimes these symptoms may fade and reappear.

Men and women often have different types of artery disease. This may be a key to why symptoms are not the same. Men are more likely to have significant blockage of a major artery whereas many women have no evidence of arterial blockage. Women are more likely to have microvascular disease, which affects the heart’s smaller blood vessels.

Because many people believe that women are less likely to have a heart attack—combined with the differences in symptoms—may be why women don’t always realize they are having one. As a result, they may not seek treatment immediately. In one study, women did not get medical treatment for an average of 50 hours, compared to fewer than 16 hours for men. A delay in treatment contributes to a greater chance of dying from a heart attack.

In the emergency room, the lack of classic heart attack symptoms can lead to misdiagnosis, resulting in a delay in treatment. Studies show that women are less likely to receive appropriate treatment for heart attack compared to men. Even when they are treated appropriately, women often experience a higher risk of complications.

Although there have been tremendous improvements in the treatment of heart disease in women, more still needs to be done. Increased education and improved training will help the general public and medical professionals recognize the differences between men’s and women’s symptoms. In addition, more clinical research is needed to understand the reason for these gender-related differences and to better personalize the management of heart disease in women.

February is American Heart Month. Visit the American Heart Association’s website to learn more about heart disease in women.

John Chatham, DPhil, FAPS, is a professor of pathology and director of the Division of Molecular and Cellular Pathology at the University of Alabama at Birmingham.