Interview with a heart surgeon on World Heart Day: Why women’s hearts beat differently

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Cardiovascular disease is the most common cause of death in women. Nevertheless, they are more likely to be associated with men. Because they are more likely to suffer from heart disease, women are twice as likely to die from it. Why is it that the feminine heart doesn’t get as much attention? Prof. Dr. Sandra Eifert, heart surgeon and head of one of the largest European women’s heart consultations, has written a book about it together with doctor and science journalist Suzann Kirschner-Brouns: ‘Heart Consultation. Why the woman’s heart is different and how it stays healthy” (C. Bertelsmann).

In an interview with SpotOn News, Prof. Dr. Sandra Eifert explains how gender influences medical treatments, what the most common risk factors for heart disease in women are and what the ‘broken heart syndrome’ is all about.

How is the feminine heart different from the masculine heart?

Prof. Dr. Sandra Eifert: There are actually significant differences. The female heart is usually a lot smaller than the male heart and also has smaller blood vessels. There is also the influence of hormones. Due to the influence of the male hormone testosterone, the male heart has more muscle mass and is therefore stronger. This causes the woman’s heart to beat approximately ten beats more per minute.

In your book ‘Heart Consultation’ you write that women die much more often when they have a heart attack. Why is that?

Prof. Dr. Eifert: Women have been protected against heart attacks for years by female sex hormones. That is why when a heart attack occurs, they are on average ten years older than men who have a heart attack, namely 70 years.

The current German Heart Report 2022 shows that mortality after heart attacks has generally fallen sharply. That is amazing!

There are many reasons for the existing higher mortality rate among women. You start with the risk factors. Some of these are gender specific. Men and women have different symptoms. This often delays diagnosis. They may require different diagnostics than men, namely diagnostics under cardiac strain. The therapy can be different for men and women.

How big is the influence of gender in general on medicine and medical treatments?

Prof. Dr. Eifert: Depending on the disease in question, this can be major. In many areas, medicine is focused on the patient, that is, the human being. The sex differences extend across the entire course of many diseases: starting with the sex-specific risk factors that can lead to a particular disease, symptoms are often different in women than in men. This means that in women the diagnosis is made at a later time or that a different diagnosis may be necessary.

In women, cardiac diagnosis is often necessary under stress, i.e. during physical exertion.

Therapy can also vary depending on the disease. All this influences the course. There are also social factors such as communication and coping with illness, etc.

Which heart diseases are most common in women?

Prof. Dr. Eifert: Cardiac arrhythmias are more common in women because they are partly dependent on the female sex hormones/the female cycle. In addition, broken heart syndrome, myocardial infarction without obstruction/narrowing of the coronary arteries (MINOCA), spontaneous coronary dissection (SCAD), heart attack according to female risk factors, gestational heart failure (peripartum cardiomyopathy), heart disease during the hormonal transition phases, the effect of stress on the heart.

Hormones play a major role. Until menopause, the female heart and blood vessels are well protected by sex hormones against diseases such as harmful deposits, because nature wants to ensure reproduction. Men do not have this protection during these years and therefore account for two-thirds of cardiovascular disease. This protective function decreases in women after menopause, when the production of sex hormones decreases: the elasticity of blood vessels decreases, which is called increasing vascular stiffness. Not least because of this, the health risk increases: cardiovascular disease is the number one cause of death for women over 50.

It turns out that there are other diseases that affect the female heart: Cardiac arrhythmias are most common in women. There are significantly more heart valve diseases and other forms of heart failure in women: while the pumping function of men often becomes weaker, women are more likely to have a disturbance in the relaxation phase of the heart, the so-called diastolic pump dysfunction. can’t recover either. Heart attacks also manifest differently in women than men – although they are rarer.

Do women have different risk factors when it comes to heart health?

Prof. Dr. Eifert: The classic risk factors apply to both women and men; These include high blood pressure, diabetes, lipid metabolism disorders and smoking. They play a different role in the development of cardiovascular disease in men and women. High blood pressure and sugar are the main concerns for women. There are also pregnancy complications, rheumatic and autoimmune diseases. They lead to a twofold increased risk of stroke or heart attack over your lifetime. Rheumatism and autoimmune diseases are less common in men.

How do female hormones affect the heart?

Prof. Dr. Eifert: A big one! In terms of evolutionary biology, women’s job is to ensure the survival of humanity. During childbearing age, the heart is protected by female hormones, among other things. When this phase is over and we can no longer become pregnant, we no longer need this ‘extra protection’ from an evolutionary biological perspective. That’s why menopause doesn’t just affect the reproductive organs: estrogen keeps the heart healthy and young, protects against inflammation and arteriosclerosis, regulates blood pressure and even protects against stress. Estrogen protects women against heart attacks for about ten years longer than men.

The feel-good hormone progesterone regulates sleep, which is positive for heart health. A first symptom may be sleep disorders; This causes stress – it has a negative effect on the heart. The drop in hormones puts pressure on blood pressure and fat and sugar metabolism.

This causes changes in the cardiovascular system. Cardiac arrhythmias are also common.

You also write that women are affected by stress differently than men. Can you explain this in more detail and how it affects heart health?

Prof. Dr. Eifert: The life of the “modern” woman is characterized by multiple burdens: work, children, household, husband, parents… all these factors increase the stress level.

Women take many things to heart. Men have a clear biological advantage here thanks to testosterone. They don’t ‘take certain events to heart’ as women do. They are more resilient in this regard. Stress processing and resilience are different for men and women. Stress leads to ‘real’ heart attacks much more often in women than in men.

And anti-stress strategies can be helpful in the long run. Anti-stress strategies and behavioral therapies and, if necessary, psychotherapies (to reduce stress) can prevent heart disease.

You mentioned broken heart syndrome. What’s behind it?

Prof. Dr. Eifert: Women in particular come to a hospital with painful symptoms that resemble a heart attack – and a cardiac catheter examination is performed. This shows normal coronary arteries. It’s not a heart attack. However, there is a special shape of the left ventricle. This appears swollen and at the same time the pumping function of the heart is limited. This is a female-specific phenomenon: broken heart syndrome is diagnosed in 95 percent of women and 90 percent are postmenopausal. The clinical picture is not harmless: in acute cases there is a risk of heart failure. If left untreated, broken heart syndrome can be as life-threatening as a heart attack. If this condition is treated promptly, a quick and complete recovery is possible.

The causes are not fully understood. These symptoms often follow a strong emotional stress situation: divorce, death of a loved one, children leaving home, but also significant financial or professional concerns. In this syndrome, the heart is overstimulated by stress hormones and a pathological change occurs in the heart.

What keeps women’s hearts healthy?

Prof. Dr. Eifert: Exercise is essential for health in general and for the heart in particular. It is superior to any other form of therapy! The German Heart Foundation recommends 30 minutes of exercise five times a week, at least once a week, in such a way that the heart is also challenged – in the sense of cardio training, i.e. the training should be strenuous. For women after menopause, strength and conditioning training is a priority. In addition, the Mediterranean diet is highly recommended for the heart. Heart health starts in the mouth. And women just need to know: their hearts are more sensitive to stress than men’s hearts.

So women are advised to listen to their hearts! In any case, women and men should have complaints investigated, especially if they return or even worsen over time. (SpotOn)

Source: Blick