Cardiology | Women's hearts: risks and anatomy are different

Typical picture from the cardiac catheter laboratory: women are significantly underrepresented among cardiologists here. Photo: dpa/Hendrik Schmidt Heart attacks appear differently in women than in men. This has been read often - and also in the lay press, as experts like to call it. Now the topic has made it onto the agenda of the Heart Days, which are taking place in Hamburg until this Saturday and are organized by the German Society for Cardiology.

The aim of the major event is to present news from cardiac medicine. Sometimes the novelty consists in collecting actually known facts on a topic and gaining new insights from them. Both sexes report chest pain as a symptom of a heart attack. But the women report other complaints: headaches, back pain, nausea. Sufficient to distract the specialist staff - and as a result, the correct suspected diagnosis often comes much later. This could contribute to the fact that mortality from coronary heart disease (CHD), which can manifest itself acutely in a heart attack, is different between the sexes. This mortality rate in clinics is 14.4 percent for women and 10.1 percent for men - although women are only half as likely to be affected by CHD.

»At 11 percent, female cardiologists are underrepresented in the cardiac catheter laboratory compared to their male colleagues.«

The risks of cardiovascular disease are also distributed differently: men are at the forefront when it comes to high blood pressure, obesity, diabetes and smoking, or these risk factors appear in them at a younger age. That doesn't mean they're safe for women. But for them, illnesses are more likely to be caused by stress, depression or autoimmune diseases. According to Tanja Katharina Rudolph, who heads a catheter laboratory at the North Rhine-Westphalia Heart and Diabetes Center in Bad Oeynhausen, women-specific risk factors are hardly taken into account in everyday clinical practice.

For example, if physical sexual maturity occurs before the age of 12, the lifetime risk of cardiovascular events increases. Or chemotherapy and radiation for breast cancer increase the risk of acute coronary syndrome. Even if menopause begins before the age of 52, things are less favorable for heart health.

There are also anatomical differences. In the cardiac catheter laboratory, a fine tube is advanced either through an artery in the wrist or in the groin to the heart in order to examine coronary arteries, chambers or pulmonary vessels or to widen narrowed vessels and support them with stents. But the catheters, says cardiologist Rudolph, “are made for the male heart.” As a result, women are more likely to experience bleeding and other complications in connection with the procedures mentioned. In addition, women are three times more likely to have a myocardial infarction without a coronary artery being narrowed. Disturbances of the microcirculation in the heart are also more common in women - which means that a different diagnosis is necessary than that determined by medical guidelines for men.

A clear gender gap then opens up in the gender distribution among the specialists, explains Rudolph: “At 11 percent, female cardiologists are underrepresented in the cardiac catheter laboratory compared to their male colleagues. A trend that can be followed across the EU, although Spain and Italy, for example, are a step ahead of Germany with 20 and 19 percent. The reasons for the low participation of women in interventional cardiology are easy to find: radiation exposure, on-call duty with night shifts and a lack of career opportunities as well as a lack of positive role models - this is what a survey on the subject revealed. Since 80 percent of medical students are female, cardiac medicine should start recruiting young people early in their studies, recommends Rudolph.

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