Should heart advice be different for men and women?

A new study, the first ever to look at the gender-based benefits of diet on heart disease risk highlights a broader issue: men and women have different risk factors, symptoms and types of heart attack and heart disease, yet currently receive the same broad advice.

Heart problems, as well as healthy heart advice, is not always the same for women.Credit:Getty

The guidelines for heart health have been based on studies looking mainly at men, explains Associate Professor Sarah Zaman, a cardiologist and researcher into women’s heart disease at the University of Sydney and Westmead Hospital.

Historically, Zaman adds, it has also been seen as a “man’s disease”: “When you imagine someone having a heart attack, you probably think of an overweight, middle, middle-aged man.”

Yet, heart attacks are the number-one killer for women globally. “About a third of women will die from heart disease,” says Dr Elizabeth Paratz, a cardiologist at the Baker Institute.

It has also become increasingly evident that there are many differences in heart disease between men and women.

While core risk factors like smoking, elevated cholesterol, high blood pressure and diabetes apply equally to both sexes, women have unique risk factors.

Preeclampsia, high blood pressure in pregnancy and gestational diabetes all increase a women’s risk of heart disease later in life. And, with the onset of menopause and the drop in oestrogen levels, women lose a protective factor and acquire the same risk as men.

The hormonal differences and changes can also influence the symptoms and type of heart disease they develop.

For instance, women are less likely to experience the stereotypical symptoms of a heart attack like crushing chest pain or pressure and more likely to have shortness of breath or stomach pain.

“Women also more frequently have a slightly different kind of heart attack,” adds Paratz. “The classic heart attack is one where you’ve got a cholesterol-based blockage in your arteries. But, you can have other heart attacks where the vessel just tears. That’s called a spontaneous coronary artery dissection and that’s much more common in women than men by ratio of about four to one.”

Women are less likely to experience the stereotypical symptoms of a heart attack like crushing chest pain or pressure.

This kind of heart attack can occur in women who have none of those traditional risk factors like high blood pressure, high cholesterol or diabetes, Paratz says: “It can just sort of occur out the blue.”

Along with increasing knowledge of the differences has come an understanding that the same treatment advice is not always helpful.

“A recent study showed half the dose [of medication] was beneficial in women without the adverse side effects,” Zaman says. “You just assume that whatever treatment and recommendations you give to women, it would just be the exact same recommendations as you give to men. But in reality, it’s actually not the case.”

It was “natural” then that Zaman wanted to look into whether there were sex differences in preventative interventions like diet.

For the study, published today in Heart Journal, Zaman and her team analysed the data from 16 different papers with more than 722,000 female participants who were followed up an average of 12 years later.

They found that the women who followed a Mediterranean-style diet reduced their risk of developing heart disease by 24 per cent and their risk of dying by 23 per cent.

While this reduction is similar in men, and it is not the first study to suggest the Mediterranean-style diet is good for heart health, it is the first to look specifically in women in an effort to start teasing out the differences, Zaman says. Currently, only 1 in 13 Australian women eat the recommended two fruits and five vegetables each day.

The Mediterranean-style diet is, of course, not the only healthy pattern of eating, but is likely to be beneficial because it is low in ultra-processed foods, which increase inflammation in the body, and high in fresh fruits, vegetables, and whole grains with all of their fibre, antioxidants and polyphenols as well as good fats and Omega 3s from olive oil, nuts, seeds and fish.

Eating whole grains and seeds, such as buckwheat, can be beneficial to heart health.Credit:Elenathewise

“Different fats influence your lipid levels differently,” Zaman explains. “They influence your blood pressure, they can influence your metabolic markers and, and development of things like metabolic syndrome and diabetes.”

As for the inclusion of eggs and meat, Zaman says there is nothing wrong with eggs, and she has no issue with non-processed meats, but avoiding processed foods in general, including processed meat, is a good idea.

It might be stating the obvious to say that we are less likely to become ill if we eat more fresh foods and less processed foods, but we don’t live in a heart healthy environment, Zaman says, so we have to go against the grain to do the basic things to support our heart’s health.

Paratz adds that the research doesn’t suggest that the Mediterranean diet is going to reverse heart disease “or anything magical like that”.

But, it does add to the evidence that, as part of a healthy lifestyle, it can help to prevent it. And for women, who are more likely to ignore symptoms of heart disease and heart attack, it’s an equally important message: “Making sure you follow a healthy diet is a great idea and way to protect your heart. And the Mediterranean diet is an increasingly scientifically validated one.”

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