What Is Cardiovascular Disease and How Does It Affect Women Differently?

Key Takeaways:

• Understanding what cardiovascular disease is starts with recognising that it refers to conditions affecting the heart and blood vessels.
• In women, heart disease may involve not only major artery blockages but also smaller blood vessel dysfunction, artery spasms or dissection, which can make symptoms harder to detect.
• Conditions such as spontaneous coronary artery dissection and Takotsubo cardiomyopathy also show that women’s heart disease can present differently.

Introduction

Cardiovascular disease is often spoken about as a general health concern, but for many women, it still feels distant until symptoms appear in unexpected ways. In Singapore, this gap in awareness matters.

Heart disease is still commonly seen as a “man’s disease”. Many women may worry more about breast cancer than heart disease, even though cardiovascular disease remains one of the leading causes of death among women. Understanding what cardiovascular disease is and how it can affect women differently is an important first step.

Although more women under 55 are being diagnosed with CVD, the condition remains more common in older women. Differences in biology, symptom presentation and disease patterns mean that cardiovascular disease in women can look and behave differently compared to men.

What Is Cardiovascular Disease?

Cardiovascular disease, or CVD, refers to a group of conditions that affect the heart and blood vessels. These include coronary artery disease, heart attacks, stroke, heart failure and other conditions involving circulation.

A heart attack happens when the blood supply to the heart muscle is reduced or blocked. This usually occurs when the coronary arteries, which supply oxygen-rich blood to the heart, become narrowed or obstructed. Without enough blood flow, part of the heart muscle can become damaged.

Among women, the spectrum of coronary artery disease (CAD) can include:

• Obstructive coronary artery disease
• Coronary microvasculature dysfunction
• Endothelial dysfunction
• Vasospasm
• Coronary artery dissection

This is one reason heart disease in women may be more difficult to detect. A woman may experience serious heart-related symptoms even when standard tests do not show the typical major artery blockage often associated with heart attacks.

Types of Heart Disease Seen in Women

Some heart conditions are especially important in conversations about women’s heart health. Two examples are spontaneous coronary artery dissection and Takotsubo cardiomyopathy.

Spontaneous coronary artery dissection, also known as SCAD, happens when a tear forms in a blood vessel in the heart. This can reduce or block blood flow and may lead to a heart attack. SCAD can be serious and, in some cases, fatal.

Takotsubo cardiomyopathy, often called broken heart syndrome, is another condition seen more often in older post-menopausal women. It happens when the heart becomes temporarily weakened, often after intense emotional or physical stress. Severe stress can trigger a heart attack-like event even without the usual artery blockage. Stress hormones may cause arteries to constrict, reducing blood supply to the heart muscle.

Both conditions show why women’s heart disease cannot always be understood through the same lens as men’s. Emotional stress, hormonal changes and differences in blood vessel response can all play a role.

How Heart Disease Symptoms Can Differ in Women

A clearer understanding of what cardiovascular disease is also helps explain why symptoms can differ from person to person. Chest pain is often seen as the classic warning sign of heart disease or a heart attack, but women may also experience symptoms that are more varied or less obvious.

Women may experience upper-body pain, nausea, shortness of breath, cold sweats, light-headedness, dizziness or unusual fatigue. Some may feel discomfort in the jaw, neck, upper back or shoulder instead of the crushing chest pain many people associate with a heart attack.

This matters because symptoms that seem vague may be mistaken for indigestion, stress, tiredness or anxiety. A woman who feels unusually exhausted or breathless may not immediately think of her heart. However, when symptoms are sudden, unexplained, severe or accompanied by other warning signs, medical attention should not be delayed.

Risk Factors Unique or More Relevant to Women

Women’s cardiovascular risk is shaped by a combination of age, hormones, pregnancy history, lifestyle factors and underlying medical conditions. Although cardiovascular disease is becoming more common among women below 55, it remains more common in older women.

One major factor is menopause. Before menopause, oestrogen may offer some protection by helping to regulate blood cholesterol levels, supporting blood vessel relaxation and reducing the risk of coronary artery disease. After menopause, oestrogen levels decline, which can increase the risk of heart disease and heart attack.

Pregnancy-related complications can also provide important clues about future heart health. Conditions such as pre-eclampsia, gestational diabetes, gestational hypertension, pre-term birth and early menopause have been linked with higher long-term cardiovascular risk.

These factors mean that women should not only think about heart health when they are older. A woman’s reproductive and pregnancy history can help doctors better understand her cardiovascular risk across different stages of life.

Debunking Common Myths About Women and Heart Disease

Myth 1: Heart Disease Is a “Man’s Disease”

One common myth about cardiovascular disease is that it mainly affects men. In reality, cardiovascular disease is a leading cause of death among women in Singapore. SingHealth reports that one in three women dies of cardiovascular disease, including heart disease and stroke, in Singapore.

Myth 2: Breast Cancer Kills More Women Than CVD

Another myth is that breast cancer kills more women than cardiovascular disease. Breast cancer is a serious concern, but it should not overshadow the threat of heart disease. Cardiovascular disease remains a major cause of mortality in women and deserves similar attention in public awareness, prevention and early recognition.

Myth 3: Heart Disease Does Not Affect Young Women

A third myth is that young women do not need to worry about heart disease. In fact, the number of young women admitted for a heart attack has increased. A recent study published in the Journal of the American Heart Association found that deaths after a first severe heart attack have increased among younger adults. The research showed a 1.2% absolute rise in death rates among adults under 55 who were hospitalised for a first heart attack between 2011 and 2022. The study also found that younger women were more likely than men to die after their first heart attack.

Myth 4: Symptoms Are the Same for Everyone

Finally, many people believe symptoms are the same for everyone. Women’s symptoms may be less typical, which can delay action. This makes awareness especially important, not only for women themselves but also for families, colleagues and caregivers who may be present when symptoms appear.

Raising Awareness of Women’s Heart Health in Singapore

Cardiovascular disease remains a major health issue in Singapore, and women should not have to wait for a crisis before paying attention to their heart health. Awareness begins with understanding what cardiovascular disease is and its risk, as well as seeking appropriate medical advice when something feels unusual.

For women who have gone through menopause, experienced pregnancy complications or have risk factors such as high blood pressure, diabetes, high blood cholesterol, smoking, excess weight or a sedentary lifestyle, regular health checks can support earlier detection and better prevention.

At the same time, families and communities play a role. When women’s symptoms are taken seriously, they are more likely to receive timely care. When more people learn CPR and AED skills, bystanders are better prepared to respond during emergencies.

To learn more about women’s heart health, visit https://www.myheart.org.sg/health/womens-heart-health/