Why Women Are More Likely to Have a Silent Heart Attack – And How to Prevent It

Dr. Janet Zand
March 24, 2019


We often praise women for their ability to juggle. We handle family, work, households, heart attack symptoms, holidays, and more – and make it look easy.

Wait – heart attack symptoms? Unfortunately, yes. Heart disease is the number-one killer of women. And it’s in part because women are much more likely than men to brush aside heart attack symptoms rather than seek help. Plus, in women, a heart attack may not present with the classic chest pain or numb arm. The signs are easier to miss.

Chest pain or pressure; arm, neck, or shoulder pain; and shortness of breath certainly can indicate a heart attack. If you experience these, you should seek help immediately. But there are a number of other symptoms to look out for as well. And some of them show up well before a heart attack actually occurs.

So we ignore the issues and press on – a juggling act that can ultimately be deadly. It’s vital that women know what symptoms should function as big STOP signs so we can get the help we need before it’s too late.

Typically the sooner you get treatment, the better the outcome. So don’t chalk these symptoms up to a long day or extra balls in the air.

For women, feeling dizzy, lightheaded, or faint is a common indicator of cardiac trouble. Extreme fatigue, back or jaw pain, and even heartburn, indigestion, nausea, and vomiting can be signs as well. Some women report a feeling of pressure, tightness, aching, burning, sharpness, fullness, or tingling in various areas of the upper body.

Women with heart disease often notice unusual fatigue, sleep issues, and shortness of breath for up to a month before a heart attack. Getting care before the heart attack occurs can dramatically increase your chances of survival.

Try to take inventory of how you’re feeling on a regular basis. If you notice any changes, talk to your doctor. Don’t dismiss them or attribute them to stress or a fast-paced life. Stress could very well be driving your symptoms. But stress could drive you all the way to a heart attack if you don’t address it and the underlying issues with your heart.

It’s good to seek help immediately if you think you’re having a heart attack. It’s better to notice symptoms in the weeks leading up to a heart attack and intervene then. And of course, it’s best to live a heart-healthy lifestyle so you can ward off heart disease in the first place.

Strategies to Avoid a Heart Attack

I’m sure you know many of these strategies. But it’s good to have a reminder, especially when you have a lot on your plate. Women often carry loads that are heavier than they need to be. If you have a heart attack, you must ask for help. But it’s far better to ask for help with your day-to-day load before you get to that point.

One of the best ways to address stress is to exercise. I know you might not think you have time in your busy schedule. But making time for exercise can actually make you feel like you have more time.

You’ll likely have more energy. You’ll probably sleep better. Many women find that exercising clears their minds and significantly reduces their stress levels. And, of course, it significantly reduces your cardiovascular-disease (CVD) risk. I guarantee you’ll find having CVD time-consuming.

In fact, a 2012 study attributed 6% of coronary heart disease simply to physical inactivity. And exercise helps with many other risk factors, such as blood pressure and cholesterol levels.

In a systematic review, researchers looked at 25 other review studies to determine just how much exercise people need to protect their hearts. First, they confirmed that exercise is essential: the most active people decrease their risk of heart disease by approximately 40% compared to people who don’t exercise at all.

In addition to the current recommendations of at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise weekly, the researchers also recommend that people try to stay as active as possible throughout their days.

Little pockets of activity, such as cleaning up the yard or walking instead of driving to a nearby appointment, can really add up. These activity periods are particularly beneficial if you engage in them instead of a sedentary activity. Try going for a walk with your spouse rather than watching TV together, for example.

Getting Beyond Mainstream Advice

Most of the advice you’ve read so far is probably not new. But there are a few things beyond this that can help.

One way to beat stress and protect your heart is less well-known than exercise: simply drink tea. And not just any tea. Research has found that tea made from a particular plant has some surprising heart-health benefits.

When we think of the hibiscus flower, we usually think of a tropical island. And planning a getaway will likely reduce your stress quite a bit! But if you’re landlocked, you can channel the tropics by making hibiscus tea.

Many people find the ritual of making and drinking tea to be soothing and stress-reducing. And hibiscus tea may help protect your heart further by lowering your LDL cholesterol.

In a 2012 study, researchers assigned participants to either a control group or a hibiscus tea group. They asked all participants to eat a healthy diet, exercise, and drink two cups of either hibiscus tea or black tea between meals for 12 weeks.

The researchers found that even though all of the participants struggled to follow the dietary guidelines, those who received the hibiscus tea still saw improvements in total cholesterol and LDL cholesterol compared to the control group.

The researchers believe the hibiscus tea was effective because it contains anthocyanins (which give it a lovely color), other antioxidants, and even soluble fiber. Tea certainly isn’t a substitute for a healthy diet or exercise regimen, but it can be a good addition to these habits, particularly if it relaxes you. 

The Sunshine Vitamin Can Help

It turns out that the “sunshine vitamin,” vitamin D3, offers quite a bit of protection against CVD.

Researchers at Ohio University have been examining the effects of this vitamin on endothelial cells. These cells play an important role in regulating the cardiovascular system. And the researchers have found that vitamin D3 helps reduce oxidative stress in the cardiovascular system and promotes the work of nitric oxide.

You’ve probably heard me talk about nitric oxide before. This tiny gas molecule is vital to healthy circulation and helps keep clots from forming. Nitric oxide production declines as we age, which is a big contributor to the rise in CVD we see in the elderly.

Moreover, the researchers also found that vitamin D3 helps restore the endothelial cells in the cardiovascular system after disease like hypertension, atherosclerosis, and diabetes damage it. Very few repair mechanisms for these cells are known, so this is important information for anyone suffering from a chronic illness. The researchers believe vitamin D3 can also help repair cardiac endothelium after a heart attack and capillary endothelium after a stroke.

Research has often linked vitamin D3 deficiency to cardiovascular issues. While the deficiency itself doesn’t cause heart attacks, the lack of protection and restoration might. To avoid a vitamin D3 deficiency, I recommend taking a supplement.

Your body will make this vitamin in response to the sun. But you have to be vigilant to make sure you get the right amount of sun every day without getting so much that you increase your risk of skin cancer. It’s far easier to take a supplement and wear sunscreen (yes, even on a tropical vacation) to protect your heart and your skin.

Heart Health Starts in the Gut

Finally, to keep your heart healthy, you may want to consider the health of your digestive system. Yes, believe it or not, the state of your gut affects the state of your cardiovascular system.

Researchers conducted a study with mice in which the mice received either a standard diet or a Western diet for five months. The researchers found that the Western diet caused gut dysbiosis in the mice and caused their arteries to stiffen. This, in turn, led to vascular dysfunction, a precursor to CVD.

The researchers further divided the Western diet mice into two groups. One group received a broad-spectrum antibiotic cocktail in their drinking water. This helped resolve the gut dysbiosis issue and the arterial stiffness. This indicates that the unfriendly bacteria that had taken up residence in the mice’s guts were responsible for their vascular dysfunction.

Of course, I think that we need to save antibiotics for serious bacterial infections. You can’t use them to try to reverse the effects of an unhealthy diet. But this study does provide an important reminder of how interrelated the systems in our bodies are.

An imbalance in your gut bacteria can lead to intestinal permeability. This in turn creates inflammation throughout the body. And that inflammation can damage your arteries and ultimately lead to a heart attack or other cardiac event. Plus, eating poorly can create regular intestinal distress that could mask the warning signs of a heart attack if you do suffer one.

The key to protecting the mice in the study wasn’t giving them an antibiotic. It was not feeding them a Western diet in the first place. To avoid gut dysbiosis, eat plenty of plant-based foods. The fiber in plants feeds the friendly bacteria that we want to be in charge in our guts. Taking a high-quality probiotic can help as well.

I’ve written quite a bit already about how to create a healthy gut, so you can check the archives if you want more information. But if you’ve put gut health on the backburner because you’re most worried about your heart, it’s time to give it a second look. A healthy gut truly is foundational to a healthy body.

Exercising and eating right will help protect your heart. But they’ll also help you feel better on a day-to-day basis. And that will help you more easily recognize the signs of a heart attack—in the rare event that you still suffer one.

After all, if you generally feel lousy, you may not really notice if you start to feel worse. But if you’re typically full of energy, unusual fatigue will be, well, unusual. And hopefully enough to motivate you to get the help you need before it’s too late.

I know you’re probably juggling a lot. But be sure some of the balls you have in the air are exercise, eating right, stress management, and getting other vitamins and nutrients to protect your heart. These healthy habits will help you avoid dropping all the balls at once.

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