Man's heart vs woman's heart; who's more at risk of a heart attack or stroke?

For many years it has been known that men and women experience a heart attack in very different ways. One of the distinguishing features of the disease in both sexes is that women are more likely to have what specialists call a silent heart attack, which can occur with hardly any symptoms. Now, cardiologists have seen a new variable that works even more against women. The classic risk factors - poor diet, lack of exercise and everything else - affect women far more than men. Therefore, it is their responsibility to take care of themselves, just that little bit more.

The warning was issued by the American College of Cardiology (a non-profit society) and in medicine, as we know, what comes out of the United States sets the tone for the rest of the world, even if the work has, as in this case, a Canadian seal. At the society's annual scientific conference in April this year, US cardiologists presented a detailed study that explores the intricacies of this issue, which surprised even its own authors. "There is no universal solution. This is all new to us, we've never seen anything like this before," said Professor Maneesh Sud of Toronto's Sunnybrook Health Sciences Centre, lead author of the study.

The research study evaluated the impact on men and women of what are considered the eight traditional risk factors associated with heart disease. These are known as inadequate diet, poor sleep, lack of physical activity, smoking and a high body mass index (BMI), plus high blood sugar (glycemia), inadequate fats (lipids) and inadequate blood pressure, which is the force exerted by blood on veins and arteries.

The interesting thing about the study is that women enjoy better heart health than men, apparently, as has traditionally been suspected, because of the protection that female hormones provide them, that is, until they reach menopause. However, as has been seen, any exposure to these hormones has far greater consequences for their heart health than in men. They are more likely to suffer a cardiovascular incident of some kind and for it to have worse consequences.

To reach these conclusions, the study's authors analysed data from more than 175,000 Canadian adults, collected through the Ontario Health Study, conducted between 2009 and 2017. None of them had any heart disease at the start of the study and approximately 70% of the subjects analysed were women, according to the information provided. Based on each of the eight aforementioned risk factors, participants were classified with a particular health profile. Those with fewer than five positive traits were considered 'poor', five to seven traits as 'intermediate' and those with all eight positive traits were considered 'ideal'.

During the 11-year study, the researchers tracked whether the participants had suffered a heart attack, cerebrovascular accident (stroke), angina and peripheral arterial disease (narrowing of blood vessels in the arms or legs). They also assessed whether any of them had undergone surgery to reopen blocked arteries (coronary artery bypass), which is performed when a bolus (lump) of fat blocks an artery temporarily (angina) or permanently (heart attack).

As expected, the risk was higher for those in poorer health. What the scientists did not expect to find was that the risk for women in poor health was twice as high as for men in the same condition. For women, the odds increased fivefold, while for men it was only 2.5. Among the 'intermediate' health population, the ratio was 2.3 (women) versus 1.6 (men).

Researchers do not know exactly what causes this new reality. It is possible, they say, that biological or sociocultural factors are involved, but they do not even dare to formulate a hypothesis. Further research in the future will clarify the mystery, which once again highlights the need for science to distinguish between the biology of men and women.

Illness, whatever it may be, does not have an equal impact on the physical and emotional wellbeing of men and women because, clearly, we are all different. Researchers have now set out to determine the extent to which menopause and race or ethnicity impact cardiovascular health.