The female factor
April 14, 2014
With any disease or illness, there are a number of factors behind what causes them, such as diet, genetic history and lifestyle habits. But how much does gender, or biological sex, play a role? More than one might think. For certain health issues, gender can be a significant factor, influencing both treatment and outcomes. When it comes to women, there are some diseases they're more at risk for that aren't directly linked to sex. One of the most common health issues with a gender disparity is heart disease. While heart disease is the No. 1 killer for both sexes in the U.S., more women die of heart disease than men.
"We used to think women were protected (from cardiovascular disease) by their hormones," said Dr. Robert Orr, cardiologist at Vail Valley Medical Center's Cardiology Institute. "That's not the case at all. The deaths from heart disease in women is higher than all the female cancers combined."
Lack of awareness and misdiagnosis
The American Cancer Society estimates that 40,000 women will die from breast cancer this year. Compare this to the almost 300,000 women who died from cardiovascular disease in 2009, according to a report from the Center for Disease Control and Prevention.
There are a number of reasons why women are more at risk for heart disease than men. During heart surgery there is a higher rate of complications in women, and the symptoms of a heart attack tend to be less obvious. It's not as simple as experiencing chest pains, which is a typical symptom in men.
"The most common symptom of a heart attack for women is fatigue," Orr said. "A lot of times it's misdiagnosed, (and) a lot of times it's under-diagnosed. Because the symptoms tend to be so vague, doctor's don't pick up on it."
Orr said the medical community has increased their efforts to monitor women for heart disease, and because of the risks, he stresses that women's cholesterol and blood pressure levels should be more tightly controlled than men. However, many women still don't realize how much at risk for heart disease they really are.
"Breast cancer does capture a lot of attention," Orr said. "Women are very in tune with that, and (many) women in middle age know someone who has had breast cancer. They tend to forget the fact that they have a very high risk of heart disease."
'Broken hearts' and reducing the risk
One of the reasons why more women die from heart disease than men is due to the types of cardiovascular diseases they're more likely to have. Women are at a higher risk for coronary microvascular disease, MVD for short, also known as small vessel disease, which is more difficult to fix than large vessel disease.
Takotsubo cardiomyopathy, often referred to as "broken heart syndrome," mimics a heart attack but it's actually not. "Broken heart syndrome" occurs almost exclusively in women and is caused by severe stress, sometimes brought on by relationship problems or matters of the romantic heart, so to speak. Orr said when women experiencing chest pains, shortness of breath and other symptoms are examined by a doctor, their heart and artery function is perfectly normal.
Curiously enough, having practiced in Boston, California and now Colorado, Orr said he sees more women with "broken heart syndrome" on the West Coast than the East. This may say more about the men on the West Coast than the women themselves. Watch out ladies; mountain men and surfer dudes might be more dangerous than you think.
Broken hearts aside, heart disease is a huge issue that can even affect younger women. Orr recommends women over the age of 18 know their medical family history, their cholesterol levels and their blood pressure. Monitoring these things at a young age is their best chance for reducing their risk of heart disease later in life. Smoking can also significantly increase a woman's risk for heart disease.
Orr often tells women about a 32 year-old female patient he treated during his fellowship who had a heart attack.
"Her only risk factor was smoking," Orr said. "I told her at the time (smoking) was extremely high risk and she needed to stop. Less than a year later she came in dead because she continued to smoke. She didn't have high blood pressure or high cholesterol. She didn't have any other risk factors at all."
Gender's influence on mental health
In addition to heart disease, another area where women are more at risk is mental health. According to the National Institute of Mental Health, women are 70 percent more likely to experience depression in their lifetime than men. Some think this statistic might be a bit skewed because women are more likely to seek treatment for depression and be diagnosed by their doctors as such. Kris Vandenberg, DNP psychiatric nurse practitioner at Mind Springs Health in Vail, said while it's true women seek help and are diagnosed more often, they're also more prone to have depression in the first place.
"Most of the research is showing now that women are more pre-disposed for a variety of reasons, whether they be psychological, genetic or environmental," Vandenberg said.
Although women are more likely to have depression, men are more likely to commit suicide. Vandenberg said this is due to men employing more lethal means to end their life, such as using a gun or hanging themselves as opposed to ingesting pills.
"The depression just builds up and up until (suicide's) the only option (they) can see," Vandenberg said. "From my experience, it seems as though men have been suffering with depression for a longer period of time when they seek treatment initially than women. There still remains a stigma with psychiatry … If (men) are not being diagnosed with depression (at their primary care providers), they're not (always) comfortable with going to a psychiatric clinic or seeing a mental health provider."
Vandenberg said for both men and women, we need to bridge the gap between primary care and mental health.
"In a primary care setting there's less time," Vandenberg said. "The patient tends to focus more on physical symptoms. Whether it be a stomach ache or nausea, it could be a symptom of depression. I think primary care providers are starting to be better trained on that."
It can be difficult to discern just how much biological sex plays a role in both physical and mental health issues. Through research we can discover that more women are affected by a particular issue, but unearthing why may be a bit trickier.
"You have to look at so many factors and it's hard to tease those out," Vandenberg said. "There's so much we don't know about depression, ADHD, alcohol dependency, etc. because the brain is understudied. It's of those things we don't know a whole lot about."
Knowing the exact reason why women are more predisposed to certain diseases than men may still be a bit of a mystery, but one can still take steps to reduce their risk. Especially for women, the simple act of being aware that they are more at risk for things like heart disease and depression can help prevent and protect them from these health problems in the future.
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