Does heart disease look different in men and women? Cardiologist shares what he learned in 20 years of experience

Heart disease can often present differently in men and women. Dr Bhojraj explains why he doesn't ask the same questions about heart disease to both sexes.

Heart disease does not always look the same in men and women. While symptoms can vary, biological differences also mean that the risk factors, disease progression and cardiovascular risks may differ between the sexes. Understanding these distinctions is important, as treating heart disease as a one-size-fits-all condition can overlook factors that may influence an individual’s risk.

Dr Sanjay Bhojraj, an interventional cardiologist and functional medicine expert with over 20 years of experience, is breaking down how heart disease can differ between men and women, including variations in symptoms, risk factors and cardiovascular risks. In an Instagram video shared on August 20, he highlights, “Men and women can walk into my office at the exact same age with similar numbers, and I may ask them very different questions. That’s one of the things cardiology has taught me: context matters.”

Heart disease in men

Symptoms of cardiovascular disease can often manifest differently in men and women. Due to biological differences, men may also develop heart disease at an earlier age than women. Dr Bhojraj emphasises that he considers not only the symptoms but also individual risk factors when assessing patients, allowing him to tailor the treatment plan accordingly.

The cardiologist explains, “Men tend to show up with cardiovascular disease earlier. That’s something I’ve seen clinically and it shows up in the population data too. So when I'm sitting across from a man in his 40s or 50s with a family history, high blood pressure, or metabolic issues, I’m usually not interested in waiting for symptoms to make the conversation feel urgent.”

Heart disease in women

For women, the risk factors for cardiovascular disease can differ and extend beyond age alone. Hormonal changes also play an important role in cardiovascular health, while life stages and events such as pregnancy and menopause can influence a woman's risk of developing heart disease and should be taken into consideration.

Dr Bhojraj highlights, “With women, I ask questions that wouldn't even come up with a male patient. What happened during pregnancy? Any history of preeclampsia or gestational hypertension? When did menopause start? Those can sound like OB/GYN details, but they can tell me a lot about cardiovascular risk years later.”

Difference in degree of heart disease

According to the cardiologist, the impact and severity of heart disease can also differ between men and women. Even the same amount of coronary plaque may affect their cardiovascular systems differently, influencing the extent of damage and their respective risk of experiencing cardiovascular events.

Dr Bhojraj explains, “The same amount of coronary disease may not carry the same meaning in men and women. Men generally develop more coronary plaque, and often earlier. But newer research suggests women can begin having heart attacks or chest pain at lower plaque burdens, particularly after menopause. That’s why I don’t like treating two 52-year-olds as though age and cholesterol tell me the whole story.”

“Treating men and women has made me a lot more careful about assuming the same questions will get me the same answers. Sometimes the difference is biological, and sometimes it’s the history sitting in front of me. Either way, I want to know who I’m treating before I decide how worried I am,” concludes the cardiologist.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. It is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.

Dr Sanjay Bhojraj is a board-certified cardiologist with over 20 years of experience in traditional cardiology and functional medicine. Founder of the Well12 programme, he takes a holistic approach to heart health, focusing on nutrition, lifestyle, sleep and mental well-being to address the root causes of disease.