Experts are still not sure why heart attacks are more common in men than in women. But differences in risk factors (such as high cholesterol) do not explain the difference, new research shows.

The study involved nearly 34,000 people (about half of whom were women) in Norway who suffered a heart attack between 1979 and 2012. Researchers found that throughout life, men were nearly twice as likely as women to have a heart attack. That high risk persisted even after listing the traditional risk factors for heart disease, including high cholesterol, high blood pressure, diabetes, physical indications, and physical activity.

Previous studies have suggested that hormone levels occurring naturally in women can prevent heart disease before menopause when hormone levels drop. However, the risk of heart attack has changed slightly as women change menopause, making it less likely that women’s hormones will explain the findings, the authors said.

Men and women have differences in biology

Men and women tend to show differences in their anatomy and physiology, which is from the lungs and the brain reaching to the muscles and joints. Men and women also have differences in their heart plans. Compared to men, women have smaller hearts and smaller blood vessels.

“Because of these biological differences, heart disease can develop differently in women compared to men,” said Michelle O’Donoghue, MD, a cardiologist at Brigham Health and senior researcher at TIMI Study Group, where she led clinical trials examining the differences between heart disease among men and women.

And until recently, women with heart disease were diagnosed and treated like men – with the same tests, the same procedures, and the same medications.

Men and women experience cholesterol buildup in various areas

A heart attack occurs when cholesterol builds up inside the arteries and causes damage to the large blood vessels.

Men often develop this growth of plaque in the large arteries that carry blood to the heart. Women are more likely to develop this nutrient in the small blood vessels in the heart, known as microvasculature.

In addition, heart disease in both sexes is only related to cholesterol accumulation.

“Inflammation plays an important role and can help make the difference we see in women with heart disease,”

Men and women have different symptoms of a heart attack

Heart disease does not always look or feel the same for women compared to men. Men often present to health care providers with chest compressions.

Women also experience chest tightness (still a major complaint), but are more likely to also report:

Nausea

Sweating

Cleaning

Pain in the jaw, neck, throat, abdomen, or back

Women may have diseases that mimic a heart attack

Women are more likely to develop heart disease than men. For example, women are more likely to hear:

Hemorrhage: a blood vessel is trapped on the ground and mimics heart disease.

Cardiac division: the wall of the blood vessel cries.

Takotsubo cardiomyopathy: an inflammatory response that causes the heart to expand after emotional stress (also called heart disease syndrome).

“It is still known under doctors that heart disease is not the same for all genders. It is usually an ‘aha’ moment when the provider sees how many other diseases to consider when diagnosing a female patient,

Men and women may have different risk factors for a heart disease

A woman’s reproductive history can be a factor affecting her risk of developing heart disease. In fact, certain diseases that develop during pregnancy, such as preeclampsia and gestational diabetes, may be powerful predictors of future risk of heart disease.

A 2016 study from investigators at Brigham Health showed that women age 40 or younger with endometriosis were three times more likely to develop heart attack, chest pain, or require treatment for blocked arteries, compared to women without endometriosis in the same age group.

Women with endometriosis, preeclampsia or gestational diabetes should adopt heart-healthy lifestyle habits. Familiarize yourself with the signs and symptoms of a heart attack, and ask your physician to assess your risk of heart disease.

Men and women require different diagnostic care

When a woman introduces herself to a doctor with signs and symptoms of a heart attack, they can receive different diagnostic care than a man.

For example, when a heart attack is suspected, both men and women receive a troponin (cTn) cardiac test, which measures troponin levels. This protein is released into the bloodstream when heart disease has damaged the heart muscle. High troponin levels indicate high levels of heart damage. But the clinical limit for heart attack can be different for both sexes.

Some women may have a heart attack but fall below the standard of diagnosis. Providers are starting to impose sexual restrictions on certain diagnostic tests.

Heart Risk Factor: Low Testosterone

Having low testosterone levels is often thought of as a decrease in sexual drive, but it is increasingly seen as linked to heart disease and type 2 diabetes, the expert said. He notes that growing research shows that low T can be considered a risk of cardiovascular disease.

“These theories are still being studied, but we do know, for example, that people who are overweight or obese or have metabolic syndrome are more likely to have low testosterone. Metabolic syndrome (which includes high blood sugar levels, unhealthy cholesterol levels, and excessive body weight) and diabetes leading to an increased risk of heart disease.

Low testosterone is just one part of the overall picture of heart risk, says an expert. But it can be encouraging, and life-saving, to know that the changes in your sexual function are closely related to your entire body. It is worthwhile to examine yourself if something does not seem right. “Men often do not connect the problem or get tested for the risk of stroke or heart attack until it happens. But sexual problems are the message they listen to