Is gender a factor in coronary artery disease? A woman’s heart may look just like a man’s, but there are significant differences. For example, a woman’s heart is usually smaller, as are some of its interior chambers. The walls that divide some of these chambers are thinner. And while a woman’s heart pumps faster than a man’s, it ejects about 10% less blood with each squeeze.

When a woman is stressed, her pulse rate rises, and her heart pumps more blood. When a man is stressed, the arteries of his heart constrict, raising his blood pressure.

Why do these differences matter? They matter because gender plays a role in the symptoms, treatments and outcomes of Cardiovascular Disease (CVD).

1. Women have risk factors men don’t have.

Certain diseases that only affect women, such as endometriosis, polycystic ovary disease, diabetes and high blood pressure that develop during pregnancy, increase the risk of coronary artery disease, the leading cause of heart attack. Endometriosis has been found to raise the risk of developing CVD by 400% in women under age 40.

Women also share traditional risk factors with men: high blood pressure, high blood sugar levels, high cholesterol levels, smoking and obesity. Like men, women can be impacted by a family history of heart disease, particularly when a father or brother was diagnosed with CVD before age 55, or a mother or sister was diagnosed before age 65.

2. Women are generally older when they have their first heart attack.

Oestrogen offers women some protection from heart disease until after menopause, when oestrogen levels drop. This is why the average age for a heart attack is 70 in women, but 66 in men.

3. The symptoms of heart attack can be different in women.

Men often describe their chest pain during a heart attack as a crushing weight on the chest. Some women also experience chest pain, but they are more likely to have different, subtler symptoms for three or four weeks before a heart attack.

Red flags include:

New or dramatic fatigue. For example, a simple activity like making the bed makes you feel unusually tired. You aren’t exerting yourself, but you feel deeply fatigued or have a “heavy” chest. You may feel very tired, but can’t sleep well. Or you are suddenly worn out after your normal exercise routine.

Shortness of breath or sweating. Watch for this especially when either symptom occurs without exertion and when either symptom is accompanied by a symptom such as chest pain or fatigue. Look for either symptom worsening over time after exertion. Other signs are shortness of breath that worsens when lying down and is relieved when you sit up and a cold, clammy feeling that occurs without cause.

4. CVD in women is sometimes hard to diagnose.

An angiogram taken during a cardiac catheterization is the gold standard test for finding narrowings or blockages in the heart’s large arteries.

But CVD in women often affects the small arteries, which cannot be clearly seen on an angiogram. That’s why any woman who is given the “all clear” signal after an angiogram and continues to have symptoms should see a cardiologist who specialises in women with heart disease.

5. A heart attack is harder on a woman than a man.

Women don’t tend to do as well as men after a heart attack. They often require a longer hospital stay, and they are more likely to die before leaving the hospital.

This may be due to the fact that women who suffer a heart attack have more untreated risk factors, such as diabetes or high blood pressure. Sometimes, it’s because they put their families first and don’t take care of themselves.

Whether you are a man or a woman, it’s never too late to lower your chance of suffering a heart attack. It’s important for all of us to be proactive in reducing our heart attack risk.