seX & whY Episode 4 Part 2: Sex Differences in Heart Disease
Aug 4, 2017
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The podcast discusses the differences between men and women in terms of heart disease symptoms and risk factors. It explores the use of troponin to detect heart damage and the importance of considering sex and gender variables in medical treatments and outcomes. The podcast also explores different methods of cardiac evaluation for patients with chest pain, highlighting their sensitivities and limitations for both men and women.
Women tend to have more atypical symptoms of a heart attack, leading to confusion and misdiagnosis.
Certain risk factors for heart disease have a higher attributable risk in women, highlighting the importance of tailored prevention strategies.
Deep dives
Differences in Presentation of Chest Discomfort in Men and Women
Both men and women commonly present with chest discomfort as the first symptom of a heart attack. However, women tend to have more atypical symptoms and describe a cluster of symptoms, including chest pain, nausea, fatigue, shortness of breath, jaw pain, and radiation. This clustering of symptoms often leads to confusion and misdiagnosis, particularly in younger women without many risk factors, who are often misattributed as having anxiety.
Key Risk Factors for Heart Disease: Gender Differences
There are certain risk factors for heart disease that have a higher attributable risk in women compared to men. For instance, diabetes increases the risk of a heart attack about 3 to 5 times higher in women compared to men, while smoking increases the risk by 25% higher in women. The reasons behind these differences are varied, with theories suggesting that women may absorb more carcinogens from smoking and that nicotine may affect estrogen receptors, negating the protective effect of the hormone. These gender differences in risk factors highlight the importance of tailored prevention strategies.
Sex Differences in Cardiac Enzymes and Imaging Techniques
Sex and biological differences can impact the interpretation of cardiac enzymes like troponin, with men tending to have higher levels due to the size of their hearts. The use of high-sensitivity troponins has shown that different cutoffs are needed for men and women, leading to increased incidence of heart attacks being detected in women. When it comes to cardiac imaging, options such as stress echo or nuclear stress tests have similar sensitivities for both men and women. However, coronary artery CT angiograms may be more helpful for ruling out disease in men, while stress echos are preferred for women as they avoid radiation exposure.