This commentary encapsulates the spirit of the original article, infused with humor and light-hearted observations characteristic of the renowned comedians you mentioned. It aims to engage readers while delivering essential information about heart health in women.
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Heart failure in women is primarily caused by the risk factors high blood pressure, obesity and diabetes
Heart failure is a serious, incurable disease that causes distressing symptoms for those affected, such as shortness of breath during exertion, fatigue and water retention in the lungs, abdomen and legs (edema). In total, it is estimated that up to four million women and men suffer from heart failure. Women make up around half of hospital admissions for heart failure in Germany, around 224,000 hospital admissions. More women than men die from heart failure (around 23,000 women and around 15,000 men in 2022). In order to prevent heart failure from progressing, it is important to recognize the causes and symptoms early and treat them consistently with the accompanying illnesses.
“A closer look at heart failure in men and women shows that there are differences between the sexes that are relevant for the medical care of women with heart disease and for which we need to sensitize women,” emphasizes cardiologist Prof. Dr. med. Christiane Tiefenbacher, board member of the German Heart Foundation on the occasion of the Heart Foundation’s nationwide heart weeks under the motto “Strength your heart! Detecting and treating heart failure” with information below “Heart failure in women is primarily caused by the risk factors high blood pressure, obesity and diabetes. If these are present at the same time, the risk of heart failure increases significantly,” says the chief physician at the Clinic for Cardiology, Angiology and Pulmonology at Marien-Hospital Wesel. Since women are at greater risk than men from diabetes and the high blood pressure that is often associated with it, you should speak to your doctor if you have this combination. Differences in women and heart failure relate in particular to:
- the anatomy of the heart (heart size/extensibility),
- symptoms,
- risk factors and
- gender-specific causes (hormones).
Women’s hearts are smaller and stiffer
Anatomically speaking, women’s hearts are smaller and stiffer than men’s hearts and are therefore more difficult to fill with blood. This stiffness of the heart increases with age and is promoted by diseases such as high blood pressure, diabetes and other risk factors. 50 percent of patients have forms of heart failure in which the heart has an intact pumping ability but cannot absorb enough blood because it has lost its elasticity and therefore its ability to expand. Doctors call this filling disorder diastolic heart failure or heart failure with preserved pump function, or HFpEF for short (English abbreviation for Heart Failure with preserved Ejection Fraction). Common symptoms of HFpEF are shortness of breath and reduced performance.
In contrast to HFpEF, systolic heart failure involves a disruption in the pumping function of the left ventricle. This does not pump enough in the ejection phase (systole), so not enough blood with oxygen and nutrients reaches the body’s organs. Systolic heart failure usually occurs as a result of a heart attack or heart muscle disease. This heart failure with reduced ejection capacity, or HFrEF for short (Heart failure with reduced ejection fraction), is accompanied by shortness of breath, fatigue, water retention in the body and life-threatening cardiac arrhythmias. “Women increasingly suffer from a disruption in the elasticity of the heart, i.e. from diastolic heart failure,” explains cardiologist Prof. Tiefenbacher. The stiffness of a heart has only been able to be measured accurately in the last few years. “We recommend that women who have symptoms of heart failure, such as shortness of breath under stress and rapid exhaustion, go to the doctor and have an ultrasound of the heart carried out,” emphasizes the Heart Foundation board member.
Menopause: Danger of high pressure heart
As women age, their hearts become stiffer. After menopause, the loss of estrogens (female sex hormones) leads to an increase in blood pressure and increased formation of connective tissue in the heart. Before menopause, estrogens protect the heart from excess connective tissue. The decrease in the body’s estrogen level leads to the loss of the vascular-protecting effect of this hormone and thus to an increase in blood pressure. The resulting increased strain on the heart muscle leads to a thickening of the heart walls. “Unfortunately, hormone therapy cannot compensate for the lack of the body’s own estrogen,” says Prof. Tiefenbacher.
An oversupply of sugar, as in diabetes, is also unfavorable for the heart’s energy metabolism and leads to an increased release of aggressive molecules, so-called free radicals, in the cells’ power plants, the mitochondria. Doctors assume that several of these mechanisms must work together to cause diastolic heart failure. This is also called “high pressure heart”.
Regular preventive check-ups
Against this background, the German Heart Foundation advises women (and men) to have a preventive examination from the age of 40 – earlier if there is a family history – in order to regularly check blood pressure, blood sugar, blood lipids (cholesterol) and body weight. This can be a regular health check-up with a family doctor, which takes place once from the age of 18 and every three years from the age of 35 (paid by the health insurance company). “This makes it possible to uncover unrecognized risk diseases for heart attacks, strokes and heart failure,” explains Tiefenbacher. “This precaution is important. Because you can’t feel high blood pressure or high LDL cholesterol,” warns Tiefenbacher. In addition, women (like men) should ensure regular exercise (preferably in the fresh air) and a healthy diet, as well as not smoking and avoiding alcohol if possible.
Additional ultrasound and blood tests
In addition, ultrasound examinations of the carotid arteries or the pelvic and leg vessels make it possible to detect vascular calcifications at an early stage, which are still without symptoms for those affected. An ECG at rest and under stress as well as an ultrasound examination of the heart complete the spectrum of examinations. When examining the blood, two important laboratory markers are the natriuretic peptides ANP and BNP, which are increased in heart failure. As a rule, men have a greater increase due to illness, so a weaker increase in women must be seen as a warning sign. An iron deficiency can also be an indication of heart failure. More information at
Broken heart syndrome or postmenopausal stress cardiomyopathy
Takotsubo cardiomyopathy or Takotsubo syndrome (TTS), also known as broken heart syndrome, occurs almost exclusively in postmenopausal women. This life-threatening clinical picture is often triggered by great emotional or physical stress. “The symptoms are similar to a heart attack: shortness of breath, chest tightness, severe chest pain,” explains the cardiologist. With TTS – as with a heart attack – parts of the heart cannot work properly, although the cause is not a vascular occlusion. TTS is a special form of acute heart failure: the ability of the left ventricle to contract and pump oxygen-rich blood into the systemic circulation is restricted. “This condition is life-threatening. Those affected should immediately alert the emergency doctor by calling 112,” warns cardiologist and vascular specialist Prof. Tiefenbacher. Complications of TTS include cardiac arrhythmias and clot formation in the ventricle with subsequent thrombosis or vascular embolism. TTS and the resulting heart failure can be treated with medication. More information:
Danger of pregnancy cardiomyopathy and myocarditis
There are special forms of heart failure in women. Peripartum cardiomyopathy (PPCM) can occur in the last third of pregnancy and around six months after birth. This is an acute, life-threatening form of heart failure. The following symptoms are a warning sign if they occur in a woman two months before giving birth or after giving birth: sudden severe shortness of breath, weakness or accumulation of fluid in the body. “If you have these symptoms, you should see a doctor immediately,” emphasizes Prof. Tiefenbacher. This form of heart disease often develops very quickly, so you should not hesitate at the first symptoms. There are a variety of effective treatment options with medication.
Acute viral infections can trigger inflammation of the heart muscle (myocarditis) in women and men, which can also cause heart failure. However, these clinical pictures are more common and more severe in younger men. The viral flu (influenza) and Coxsackie viruses play a particular role. (wi)
Information about the topic of women’s hearts:
Service for the heart weeks
The motto of the heart weeks is “Strengthen your heart!” Recognize and treat heart failure” and are aimed at patients, relatives, doctors and everyone who is interested in the topic of heart failure. Clinics, practicing cardiologists, health insurance companies and companies are taking part in the awareness campaign. Information about patient seminars, online lectures, telephone campaigns and advice offers (text, video, podcast) is available below available or by calling 069 955128-400.
New guide to heart failure
For patients with heart failure, relatives and interested parties, the German Heart Foundation offers the new guide “Strength Your Heart! Recognize and treat heart failure. In the brochure (152 pages), renowned heart specialists provide easy-to-understand and detailed information about how heart failure occurs and what can be achieved therapeutically today with medication, interventions and sport in order to improve quality of life and lifespan. The free brochure can be ordered by phone at 069 955128-400 or by email: [email protected] from the Heart Foundation. Further information: herzstiftung.de/herzwochen and
Caption: Diabetes and other risk factors put a particular strain on women’s hearts.
Image source: Monika Gause for www.diabsite.de.
Interview with Prof. Dr. Christiane Tiefenbacher, Cardiologist and Board Member of the German Heart Foundation
Editor: Thank you for joining us, Prof. Tiefenbacher. In light of the recent commentary discussing heart failure in women, can you start by explaining why heart failure appears to affect women more severely than men?
Prof. Tiefenbacher: Absolutely, and thank you for having me. The statistics are indeed telling—23,000 women died from heart failure last year compared to 15,000 men. One reason is that women often experience heart failure with preserved ejection fraction (HFpEF), which is linked to symptoms like breathlessness and fatigue. Additionally, conditions such as high blood pressure, obesity, and diabetes disproportionately affect women, particularly after menopause when their protective hormonal shield diminishes.
Editor: What are the primary risk factors that women should be aware of regarding heart failure?
Prof. Tiefenbacher: The trio of high blood pressure, obesity, and diabetes stands out as the main culprits. These risk factors can significantly increase the risk of heart failure when present simultaneously. Moreover, women’s hearts tend to be smaller and stiffer than men’s, which complicates their heart’s ability to fill with blood effectively, leading to diastolic heart failure.
Editor: You mentioned menopause—can you elaborate on how it impacts women’s heart health?
Prof. Tiefenbacher: Certainly. Menopause marks a significant transition as the production of estrogen declines. Estrogen plays a critical role in protecting the heart and maintaining flexible blood vessels. When estrogen levels drop, women experience changes like increased blood pressure and heart wall thickening, heightening their risk for heart-related issues.
Editor: What are some proactive steps women can take to protect their heart health?
Prof. Tiefenbacher: Preventative check-ups are crucial. Women aged 40 and older should see a doctor for regular health evaluations to monitor blood pressure, cholesterol, and blood sugar levels. Early detection is essential to prevent the progression of heart disease. In addition, maintaining a healthy lifestyle through regular exercise and a balanced diet can make a significant difference.
Editor: Lastly, what is “broken heart syndrome,” and why is it particularly concerning for postmenopausal women?
Prof. Tiefenbacher: Broken heart syndrome, or Takotsubo cardiomyopathy, can occur due to extreme emotional or physical stress, and it predominantly affects postmenopausal women. It mimics a heart attack but is not caused by blocked arteries. Symptoms like chest pain and shortness of breath require immediate medical attention, as this condition can lead to severe complications.
Editor: Thank you, Prof. Tiefenbacher, for shedding light on such an important topic. It seems that awareness and preventive care are key in tackling heart failure among women.
Prof. Tiefenbacher: Exactly, and I appreciate the opportunity to discuss this. It’s vital for women to understand their heart health and take proactive steps towards prevention.
Ngaging in regular physical activity, maintaining a healthy diet, and avoiding tobacco and excessive alcohol consumption are also key factors in heart health. It’s essential for women to recognize symptoms like shortness of breath, fatigue, or any significant changes in their health and seek medical advice promptly.
Editor: Thank you for those insights, Prof. Tiefenbacher. What final message would you like to convey to women regarding heart health?
Prof. Tiefenbacher: My message would be clear: don’t underestimate the importance of your heart health. Being aware of risk factors and taking preventive measures can make all the difference. Women should take charge of their health, prioritize regular check-ups, and advocate for themselves and each other. Remember, a strong heart contributes to leading a vibrant and active life. Let’s work together to strengthen our hearts and reduce the impact of heart disease in women.
Thank you, Prof. Tiefenbacher, for your valuable insights!
Sorry, Ladies—Your Hearts Are Here for a Tough Time!
Right, let’s talk about something that’s causing a lot of distress—heart failure in women. Not exactly a dinner party topic, is it? But, before you go fainting at the thought, consider this: it’s not just a condition; it’s a thief, robbing us of breath and… well, a little thing called ‘living.’ Now, heart failure is where your heart decides to go on strike. It’s not quite as dramatic as a union protest, but it’s still serious enough to get your attention.
As we’ve learned from the fine folks at the German Heart Foundation, heart failure affects around four million people in total! That’s roughly the population of Panama for reference. Or a small country where everyone thought “I’ll sort my health later.” Oh, how wrong they were! Women seem to take the hit harder—23,000 women lost their lives to heart failure last year compared to 15,000 men. That’s right; ladies, it looks like your hearts are playing the long game, but it’s the men who are taking the shortcuts!
High Blood Pressure, Obesity, and Diabetes Walk into a Bar…
The heart-straining trio of high blood pressure, obesity, and diabetes has shown up to the party, and they’re causing a ruckus! This wonderful combination—or should I say, nightmare—can significantly increase the risk of heart failure. Is it any surprise that this cocktail of risk factors seems to have a fondness for women? It’s like they’re the chosen ones in this twisted tale of cardiac chaos!
But let’s get a tad scientific—certainly more than your average pub quiz night—because these medical types are saying that women’s hearts are smaller and stiffer. Think of it this way: it’s like trying to fit a gallon of ice cream into a pint container; it just isn’t going to work well! The stiffness increases with age, like the stubbornness of that one relative you can’t get rid of at family gatherings.
Welcome to the Menopause Wonderland
Then, there’s the menopause—an event that brings its own special brand of high-pressure heart. Picture this: estrogen (the women’s superhero hormone) jumps out of the window, leaving behind a heart that’s about as flexible as a brick. From a young age, estrogens shield women from heart issues, but that protective bubble bursts like a balloon at a kid’s birthday party when menopause strikes.
The Solution? Regular Check-ups—And No, Not at the Pub
Now, if that hasn’t put you off your pint, consider this: preventative check-ups are a must. If you’ve hit the big 4-0, it’s time for a health check-up—think of it as an annual tune-up for your body. And no, you can’t skip it just because you’re feeling fine! You wouldn’t drive a car without regular maintenance, would you? So why would you treat your heart any differently?
Don’t Let “Broken Heart Syndrome” Ruin Your Day
Oh, and whilst we’re here, let’s not forget about the “broken heart syndrome,” which, believe it or not, particularly targets postmenopausal women, just to add an unexpected cherry on top of this health sundae. Imagine having your emotions literally turn into a heart attack! Now, that’s stressful. Take the advice of the experts—if your heart is tight, or you’re feeling breathless, get that checked out. Don’t just sit there hoping it’s just a bad case of heartburn after a dodgy kebab.
In Conclusion: Ladies, Take Charge!
The long and short of it is: ladies, your hearts need a little TLC. High blood pressure, diabetes, and obesity are the rascals you want to keep an eye on. Remember, your heart isn’t just a muscle—it’s the life of the party and needs to be treated that way! So, go on, strengthen that heart of yours! And let’s make preventing heart failure the next big fad—better than any diet, I promise!
And remember, if heart disease were a reality show, you’d want to tune in early, avoid the drama, and come out on top. After all, why settle for a broken heart when you can have a strong one? Now, who’s up for a healthy salad instead of chips?