Dr. John Day, Cardiologist

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Why Do More Women Die From Atrial Fibrillation Than Men?

In this podcast, I interview Dr. Jared Bunch about the recent article he wrote for Everyday Health on this subject.  Given that 1 in 4 adults in the U.S. will experience atrial fibrillation at some point in their lives, this is an especially important topic.

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What is Atrial Fibrillation?

Atrial fibrillation is the most common heart rhythm abnormality.  In atrial fibrillation, the two upper chambers of the heart are in complete electrical chaos.  This typically results in a very fast and irregular pulse.  Patients often experience palpitations, shortness of breath, chest discomfort, and fatigue.  Surprisingly, in the inactive and elderly, people may not have any symptoms at all.

Is Atrial Fibrillation Dangerous?

Even if you have no symptoms at all, atrial fibrillation is still a very dangerous heart condition.  Patients suffering from atrial fibrillation are much more likely to have a stroke, develop dementia, or experience heart failure or a heart attack.

What is the #1 Risk for Women?

Contrary to conventional wisdom, the number one cause of death for women is not breast cancer.  In fact, it’s not even all of the cancers combined.  Rather, the number one cause of death for women is still heart disease.

Why Do Women Die More From Atrial Fibrillation Than Men?

Many studies have shown that women are more at risk from dying from atrial fibrillation than men.  We still don’t know exactly why women are more at risk than men.  There are many possible theories.

1. Women tend to be 4 years older at the time of being diagnosed with atrial fibrillation.

2. Women are less likely to be prescribed blood thinners with atrial fibrillation.

3. Women may respond differently to blood thinners than men.

4. Women with atrial fibrillation have a higher heart attack risk than men.

Two Types of Heart Attacks

In general, there are two different kinds of heart attacks.  The first is the classic form of a heart attack where a plaque in one of the arteries of the heart ruptures and blocks off blood flow in that artery.  All of the heart muscle downstream of that clot is at risk of dying.  Physicians call this kind of a heart attack a “ST elevation” myocardial infarction (STEMI) because the ST segment of the ECG is elevated.

The other form of a heart attack is where the demands of the heart exceed blood flow available.  This would be the same concept as “red lining” your car’s engine.  If you run your heart too hard for too long this can also cause heart muscle to die or a heart attack.  Physicians call this kind of a heart attack a “Non ST elevation” myocardial infarction (NSTEMI) because the ST segment of the ECG is not elevated.

Why Do Women Have More Heart Attacks With Atrial Fibrillation?

In a recently published medical study of 14,462 people that were followed for 21.6 years, researchers observed 1,374 heart attacks.  Overall, people suffering from atrial fibrillation were 63% more likely to suffer a heart attack.

These atrial fibrillation induced heart attacks appeared to be primarily the NSTEMI form where heart demands exceed blood flow to the heart rather than the classic blood clot.  Even more surprising is that most of these atrial fibrillation heart attacks occurred in women.

Just to clarify, atrial fibrillation is an electrical problem with the heart whereas a heart attack is a plumbing problem with the heart.  However, if the electrical problem (atrial fibrillation) drives the heart rate too fast for too long it can trigger a heart attack or a plumbing problem with the heart.

While a 63% increased risk of a heart attack from atrial fibrillation sounds frightening, the numbers were even more frightening if you break them down by gender.  For example, men were just 21% more likely to suffer a heart attack from their atrial fibrillation whereas women were 172% more likely to suffer a heart attack from atrial fibrillation.  Approximately 10% of people suffering from this type of a heart attack never make it out of the hospital alive.

The question then naturally arises, why were women so much more likely to suffer heart attacks from their atrial fibrillation?  Researchers were unsure exactly why women were so much more at risk.  Some theories include poor control of atrial fibrillation, untreated other medical problems, or lack of blood thinners.

What Can Women Do?

1. If you have atrial fibrillation get it treated so that you can avoid a heart attack.

2. Breathe clean air. This means no smoking or exposure to second hand smoking.

3. Reverse or control the other risk factors.  The common cardiac risk factors include high blood pressure, cholesterol, and diabetes.

4. Maintain a healthy weight.

5. Exercise every day.

6. Eat a healthy diet.

7. Manage stress, stay socially connected, and get restorative sleep at night.