Women and Cardiac Disease
Dr Narayan Gadkar, Cardiologist, Zen Multispeciality Hospital
One in 3 women die of cardiovascular disease, compared to 1 in 31 women who die of breast cancer. While the actual numbers of deaths from heart disease have declined among both men and women, more women die of cardiovascular disease each year than men. In fact, rates of heart disease among younger women (aged 35 to 54) are actually increasing, a trend thought to be attributable to obesity.
Cardiovascular disease is the leading cause of death among women. On average, women develop cardiovascular disease, on average, about 10 years later than men. It is thought that this difference is at least partially due to protective hormonal effects because women’s risk increases after menopause. Women who undergo early menopause, either due to surgical removal of their ovaries or premature ovarian failure, have similar rates of cardiovascular disease as age-matched men. Most women have one or more risk factors for cardiovascular disease.
There are notable differences in the types of heart disease that affect men and women. Differences exist in the underlying mechanisms of their heart disease, the symptoms that they present, and the types of complications they experience. There are also differences in the comprehensiveness of the medical care men and women receive and the general awareness of the magnitude of women’s cardiovascular risk compared to that of men.
The main type of Heart disease women are prone to are Coronary Heart disease, Coronary Microvascular Disease, Broken Heart syndrome,
Researchers who study the gender differences in cardiovascular disease often focus on the protective role of estrogen. Estrogen has numerous effects on vascular tissue. It relaxes blood vessels, lowering blood pressure (pre-menopausally). Estrogen blunts the effects of stress hormones (catecholamines) which are vasoactive and cause blood vessel constriction, especially in times of stress. Estrogen is also a natural antioxidant. However, estrogen also promotes blood coagulation, which isn’t helpful. This is why women who use oral contraceptives are at an increased risk of thrombotic events (blood clots). The use of hormone replacement therapy containing conjugated equine estrogens, once thought to protect women against cardiovascular disease, is now known to increase CVD.
Several types of heart disease are more common in women than in men: stroke, hypertension, endothelial dysfunction, and congestive heart failure. Because the presentation of these diseases is often less symptomatic, both women and their doctors benefit from efforts to increase awareness and practice prevention to reduce cardiovascular disease.
While men and women have similar rates of hospitalization due to heart disease, women tend to have longer hospital stays, receive less of the recommended assessment and treatment, and experience greater long-term disability. Women are less likely to return to work following a CVD-related hospital admission and have lower health-related quality of life following an event. These are important reasons for women to be well educated about what they can do to prevent heart disease and the types of treatment that should be recommended if they do have heart disease. With this knowledge, women can advocate for their own best health care
Many of the risk factors for cardiovascular disease are lifestyle behaviors. Diet, exercise, tobacco use, alcohol consumption, overweight, psychosocial stress, and depression are all significant risk factors. The good news is that these factors are largely modifiable.
Medical conditions such as obesity, diabetes, hypertension, and high cholesterol also increase women’s risk of heart disease. Women are more likely than men to have multiple risk factors. Women also have higher risks of mortality (death) when they have multiple conditions; for example, women with diabetes have an increased risk of dying of cardiovascular disease compared to men with diabetes. Additional risk factors specific to women include oral contraceptive use, hormone replacement therapy, and history of preeclampsia or gestational diabetes during pregnancy.
Many risk factors can be easily identified through routine testing and review of lifestyle habits. While simply improving the rates of basic assessment will improve CVD detection and prevention for women, in order to most accurately assess risk in women, different factors should considered in addition to the traditional markers of risk. This is because of the differences in the underlying types of CVD that affect women, and thus testing and screening should seek to identify those types of cardiovascular disease that a woman is most likely to have.
