Heart failure symptoms in women: How they’re different

In the battle between the sexes, developing heart disease is no victory. Men lead early, but women close the gap after menopause. The same is true with a related problem: heart failure.

But that’s where the parallels largely end. The type of heart failure women tend to develop is different from that commonly seen in men. And the risk factors for that type – obesity, diabetes, and high blood pressure among them – all worsen women’s outcomes more than men’s, according to the American College of Cardiology (ACC).

Because of this, heart failure symptoms in women hit harder, says Dr. Emily Lau, an assistant professor of medicine at Harvard Medical School who specializes in women’s cardiovascular health.

This form of heart failure is “a tough condition, with frequent hospitalizations. Women are disproportionately burdened,” Dr. Lau says. “There’s a myth that heart failure is a disease of men, but that’s definitely not true.”

Two main types

According to the ACC, about 7.4 million American adults have heart failure, which occurs when the organ can’t pump enough blood to meet the body’s needs. While fewer than 1% of adults ages 50 to 59 develop it, the incidence rises to about 8% in women 80 to 89, compared to 6.6% in men the same age.

Women typically have a form of the disease called heart failure with preserved ejection fraction (HFpEF), meaning the heart contracts normally but the ventricles (its two main pumping chambers) are stiff and don’t fill properly. In contrast, men are more likely to have heart failure with reduced ejection fraction (HFrEF), meaning the heart’s pumping ability is weakened. “The most common risk factor for this form is coronary artery disease – cholesterol blockages in major arteries. This is more common in men than in women,” Dr. Lau explains.

Heart failure symptoms

Symptoms common to both types of heart failure include

• shortness of breath
• swelling in the legs or abdomen
• fatigue or weakness with exercise
• waking up breathless or needing extra pillows when sleeping
• dizziness or lightheadedness.

Early signs of heart failure shouldn’t be ignored, Dr. Lau says. “If you notice you were previously able to do things like walk up and down stairs without issues, and now any activity makes you feel winded or fatigued, that’s a sign you should be evaluated further,” she says.

Sex-specific risk factors

Risk factors for heart failure also differ between the sexes. “There are a number of unique female risk factors that need to be considered,” Dr. Lau says. Pregnancy can stress the heart, and treatments for conditions more common in women – such as breast cancer – sometimes damage the organ, raising heart failure risk down the road.

Women are also more likely to develop heart failure from high blood pressure or diabetes, while men often face it after a heart attack, according to the ACC. “Men with diabetes have twice the risk of developing heart failure, but women with diabetes have five times the risk,” Dr. Lau says.

Additionally, women are more prone to inflammation in the blood vessels and the lining of the heart, as well as changes in how tiny blood vessels work, according to the ACC. This can lead to heart problems even if a woman’s coronary arteries have no blockages from fatty plaque buildup.

All of these factors underscore how important it is for women to recognize heart failure symptoms early, Dr. Lau says. “Being able to make the diagnosis early can enable us to get started sooner with therapies that both treat and prevent problems,” she says.

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