The Differences between Men and Women
Dr. Elizabeth Ross, of the Washington Hospital Center in DC, in her 1999 book "Healing the Female Heart" explained the gender differences in the causes and symptoms of heart attacks.

First, Ross explains, the female hormone estrogen significantly affects the female heart, protecting the entire female cardiovascular system from the kind of wear that men experience by the time they are 40, and in some cases even younger.

Your natural estrogen maintains a proper ratio between the "good" HDL (high-density lipoproteins) cholesterol and the "bad" LDL (low-density lipoproteins) cholesterol, and decreases fibrinogen (a protein involved in the blood's clotting system, which influences how viscous, or sticky, your blood is), among other heart-healthy jobs. That's the good news.

But that benefit stops after menopause, and a woman's lifetime risk of developing cardiovascular disease is two out of three. The risk increases if you are 20 percent or more overweight and carry that weight in your mid-section. More women die each year from heart disease than all cancers put together.

When we talk about heart disease or cardiovascular disease, we're usually talking about coronary artery disease, or atherosclerosis, where there is a narrowing of one or more of the arteries that supply blood to the heart. That narrowing is caused by the formation of plaque, which is a thick, waxy substance made up of cholesterol, smooth muscle cells, and platelets, and inflammation.

Coronary artery disease in women is generally associated with elevated serum cholesterol levels, elevated LDL levels, low HDL levels, high triglyceride levels, and hypertension (high blood pressure). Impaired tolerance to glucose, or insulin resistance, also increases a woman's risk of coronary disease. Risk factors for heart disease unique to women include, pregnancy, having had both ovaries removed, and premature menopause.

In addition, the parts of a woman's heart are generally smaller and more fragile than analogous parts in men's hearts (by about 50 to 100 grams), and women experience different symptoms during a heart attack.