Heart disease remains the leading cause of death worldwide, yet many people are unaware of its hidden risk factors and warning signs—especially in women.
A recent study published in the Journal of the American College of Cardiology analysed over 15 years of data on 1,474 heart attacks and revealed a concerning trend: nontraditional causes of heart attacks, often overlooked and misdiagnosed, pose a growing threat, particularly to women under 65.
According to the World Health Organisation (WHO), a heart attack occurs when blood flow to part of the heart muscle is suddenly blocked, most commonly by a blood clot. This blockage prevents oxygen and essential nutrients from reaching the heart muscle, causing damage. Without prompt treatment, the damage can become severe or even fatal.
Traditionally, heart attacks have been linked to clogged arteries, or atherosclerosis, which accounts for about 75 per cent of heart attacks in men.
In women, however, atherosclerosis causes only 47 per cent of heart attacks. The remaining 53 per cent are connected to other, nontraditional conditions such as microvascular disease, spontaneous coronary artery dissection (SCAD), anaemia, and stress-induced syndromes.
Diagnostic gap
These conditions often go undetected until it is too late, largely because current diagnostic tools are not designed to identify them effectively. This diagnostic gap puts women at significant risk, especially since their symptoms often differ from those seen in men and can easily be missed or misinterpreted in medical settings.
In Kenya, cardiovascular disease is among the leading causes of death. Recent national data show that non-communicable diseases now account for 61.7 per cent of all deaths in health facilities, with heart disease being a major contributor. Globally, cardiovascular disease remains the top killer, claiming an estimated 17.9 million lives annually.
For decades, the medical community has viewed heart attacks through a narrow, one-size-fits-all lens—largely based on data from men, particularly older men with blocked arteries.
However, findings from the recent study challenge this outdated model, showing that more than half of heart attacks in women under 65 are caused by nontraditional and often overlooked factors.
Most common cause
Although atherosclerosis remains the most common cause of heart attacks overall, the data show that less than half of cardiac events in women can be attributed to it.
Many heart attacks in younger and middle-aged women are linked to causes that standard diagnostic tests often miss, including microvascular dysfunction, SCAD, coronary vasospasm, Takotsubo cardiomyopathy (a stress-induced syndrome), anaemia, and various inflammatory conditions.
SCAD, in particular, is a rare but life-threatening condition involving a spontaneous tear in the coronary artery wall. It occurs nearly six times more frequently in women than in men and is often mistaken for the more common plaque-related heart attack.
This misdiagnosis can lead to unnecessary—and sometimes harmful—treatments, such as stent placement, which does not address the underlying issue.
Accurate diagnosis
Heart attacks caused by physiological stressors, such as anaemia or infections, are also linked to higher mortality rates over five years. This underscores the critical need for accurate diagnosis and personalised treatment approaches for women experiencing cardiac events.
Studies show that women are less likely than men to recognise heart attack symptoms and often delay seeking medical help, a delay that can significantly reduce survival chances.
Despite popular belief, research has found no meaningful difference in key heart attack symptoms between men and women. However, the persistent myth that women experience vastly different symptoms has led to confusion, misdiagnosis, and less aggressive treatment for female patients.
Incorrect initial diagnosis
Alarmingly, women have a 50 per cent higher chance of receiving an incorrect initial diagnosis after a heart attack compared to men. This misdiagnosis can prevent them from receiving urgent care.
Additionally, women are half as likely as men to receive recommended heart attack treatments, contributing to worse health outcomes and avoidable deaths.
A major challenge in addressing this disparity is the historical and ongoing underrepresentation of women in clinical trials.
Most heart disease studies have focused on male subjects, meaning diagnostic methods, treatment protocols, and risk assessments are often not well-suited for women. Consequently, many tools designed to save lives are less effective for half the population.
Lack of awareness
A 2017 survey of 4,000 women revealed widespread lack of awareness about heart health and major risk factors. This knowledge gap has real consequences: without proper understanding, women are less likely to take preventive measures or recognise warning signs early enough to seek help.
Several studies also indicate that women are frequently underdiagnosed and undertreated for cardiovascular diseases, partly due to disparities in healthcare access and partly because of gaps in medical training and public health messaging.
Factors unique to women’s health, such as early menstruation or early menopause, influence long-term cardiovascular risk but are rarely considered during standard health assessments.
In African countries, including Kenya, the burden of heart disease among women is further shaped by social, economic, and lifestyle factors.
Obesity
Rising obesity rates among women contribute significantly to increasing heart disease cases. Additionally, many women in Kenya and sub-Saharan Africa have limited access to quality healthcare, including diagnostic tools and cardiology specialists, making prevention, early detection, and effective treatment more difficult.
A 2022 study using data from the Kenya Demographic and Health Survey examined non-communicable disease prevalence and risk factors among women aged 15 to 49. It found that 15.9 per cent of women in this age group had at least one non-communicable disease.
Among these, hypertension was the most common, affecting 8.7 per cent of women, followed by arthritis (2.9 per cent) and depression (2.8 per cent).
Other associated risk factors included older age, being overweight or obese, alcohol use, and certain occupations.
Hypertension, long recognised as a major and modifiable heart disease risk factor, increases pressure on blood vessels and forces the heart to work harder, significantly raising the risk of heart attacks and strokes.
Controlling blood pressure through medication, regular exercise, and a healthy diet is essential to reducing heart disease risk.
These findings highlight a critical gap in how heart disease is understood, diagnosed, and treated, particularly in women.
Traditional risk assessments often fail to account for the diverse and complex causes of heart attacks in women, especially those under 65.
As a result, countless women worldwide are living with undiagnosed heart conditions—many of which could be prevented or managed with earlier intervention.
