The conventional wisdom has been that when heart disease shows up in women, it simply arrives more slowly, generally lagging about 10 to 20 years behind men. But a review of blood pressure measures for nearly 32,800 people collected over four decades casts doubt on that view—and suggests, once again, the health system must do more to recognize men and women are different, and thus, diseases act differently.
A study published recently in JAMA Cardiology found certain vascular diseases not only develop earlier but progress quickly, which the authors said can set women up for late-life heart problems “that tend to present differently, not simply later” than those in men.
The authors—who came from Harvard, Cedars-Sinai Los Angeles, and Turku University in Finland—reached their conclusions by shedding old assumptions of the past. Instead of assuming that men and women are basically the same physically, this team assumed they are different, and by looking for gender-specific differences in the blood pressure data, they uncovered new insights.
The researchers used data from 144,599 separate blood pressure readings taken between 1971 and 2014 from patients aged 5 to 98, which were recorded in four different studies.
Compared with men, women “clearly exhibit a steeper increase in [blood pressure] that begins as early as the third decade and continues throughout the life course” they wrote.
What causes gender-related differences in blood pressure? The authors say there could be a host of reasons, including hormonal factors, chromosomal factors, and differences in gene expression. Women are smaller, and their organs—including the heart—are smaller, too. The most differences are those associated with when women begin menstruating and having children; beyond the hormonal changes, blood volume increases, and so does the heart rate.
The differences beyond biology can matter, too. “Importantly, complex social, economic, and structural environmental factors lead to differences in the lived experience between men and women that can affect physiology as well as vascular biology,” the authors write.
Such differences are important because of studies of drugs developed for type 2 diabetes are now being shown to be effective in some forms of heart failure. More studies are expected that may show whether these drugs, called SGLT2 inhibitors, are effective in the form of heart failure associated with stiffness in the heart’s left ventricle. As the authors note, this dangerous condition is more likely to affect women, especially if they have high blood pressure. Right now, no drugs have been shown to prevent early death from this condition.
More work is needed, the authors said, to understand how the differences between men and women affect cardiovascular risk, so that prevention and management efforts can be tailored for each.