Women and Heart Disease

Heart disease is the leading cause of mortality in the United States, and it is commonly believed to be a male problem. However, cardiovascular disease (CVD) is the leading cause of mortality among women in the United States and globally. In 2017, 299,578 women died as a result of heart disease, accounting for almost one in every five female fatalities.

Although women appear to have an advantage over men due to the delayed beginning of their CVD, the male deficit in CVD is something of an illusion because women catch up in broad terms during their lifespan. In this post, we will look at the key differences in heart diseases between men and women.

Risk factors

• When lifetime CVD risks are taken into account, there is minimal variation between the sexes. Indeed, because women live longer lives on average, the frequency of CVD events in women may be greater than in males.

• High blood pressure and cholesterol levels, smoking, diabetes, and overweight/obesity can all place women at a higher cardiovascular risk than men.

• Women performed worse than males in meeting guideline-based targets for high-density lipoprotein cholesterol, low-density cholesterol, total cholesterol, glucose, physical activity, obesity, and cardiac rehabilitation.

Female Risk Factors

Complicated pregnancies and conditions associated to the female reproductive cycle make women more vulnerable to heart disease. It has found that the following can increase the risk of CVD in women:

• Early menarche
• Early menopause
• History of hysterectomy

Amongst those who gave birth:

• Early age at first birth
• History of miscarriage
• History of stillbirth.

Estrogen and heart disease in woman

• Endogenous oestrogen during the reproductive phase of life is widely believed to postpone the onset of CVD in women. Epidemiological research, on the other hand, shows that there is no difference in the rate of rise of CVD with age at menopause.

• Furthermore, clinical investigations have revealed that exogenous estrogen has no overall cardiovascular benefit in postmenopausal women. As a result, women may have a false sense of security about their level of protection from CVD owing to estrogen, leading them to underestimate their cardiovascular risk.

Menopause and female heart disease

• Transitioning to postmenopausal state is linked to a worsening CHD risk profile in women, implying that they are at the same level of cardiovascular risk as males.

• Menopause is linked with an increase in body weight, changes in fat distribution, centripetal obesity, and visceral fat deposition, as well as an increase in other CVD risk factors including diabetes mellitus. Diabetes, in particular, is a significant risk factor for women.

Signs and symptoms

• Heart disease symptoms affects women in different ways than it does males, and failure to recognize this has been demonstrated to have serious consequences.

• They are also less likely to have physical activity as a trigger for their MI, instead being more likely to experience emotional distress as a trigger. Furthermore, women frequently feel heart attacks differently than males, so doctors may overlook them in the acute situation.

• Not only is "tightness" or pain in the chest an indication of myocardial ischemia in women, but nausea, vomiting, and dizziness are also common symptoms.

• Breathlessness, sweating, a fluttering sensation in the heart, and a feeling of fullness in the chest are some of the other symptoms. Women may also feel back, shoulder, or jaw discomfort, as well as anxiety, as symptoms of MI.

Prognosis of heart disease in women

 Despite the fact that women acquire heart disease 10 years later than men, they are more likely to suffer from a heart attack. The following factors contribute to the worse outcomes:

1. The failure to identify heart attack symptoms.

• Approximately 35% of heart attacks in women are believed to go unnoticed or unreported.

1. Increased age:

• Women are more likely to have co-morbid diseases such as diabetes and hypertension.

• For those who survive a MI and leave hospital, women tend to have worse survival and be more likely to have a recurrent event.

Management

Women are less likely than males to receive tertiary care treatments such as cardiac catheterization, angioplasty, thrombolytic therapy, and bypass surgery; to engage in cardiac rehabilitation; and to return to full-time employment following a myocardial infarction. Therefore, this will contribute to variations in risk factors in secondary prevention.

• Some cardiac disease more common in females

• Microvascular Angina

This term refers to people who have angina symptoms and show abnormalities on stress tests while having normal coronary arteries on angiography. Women have a well-documented predisposition for developing microvascular angina. The primary goal of therapy is to manage symptoms using calcium-channel blockers and oral nitrates.

• Stress (Takotsubo) Cardiomyopathy

• Stress cardiomyopathy is caused by strong, unexpected emotional or physical stress and is characterized by temporary apical systolic failure with ballooning of the left ventricle.

• The condition primarily affects postmenopausal women. The presentation is similar to that of acute MI, with ST-segment elevation on the ECG and elevated cardiac troponin levels. Angiography, on the other hand, does not detect obstructive coronary disease.

• Although the underlying mechanisms are not completely understood, catecholamine toxicity, microvascular malfunction, and coronary artery spasm have all been identified as potential pathogenic factors. Moreover, stress cardiomyopathy may have a hereditary component in individuals who are prone to it.

Prevention

The key to heart disease prevention is:

• Stop smoking or not start it
• Treat and control blood pressure >140/90 mm Hg;
• Manage elevated lipids through diet, exercise, and cholesterol-lowering medications
• Treat diabetes; reduce weight till your BMI is below 25
• exercise for 20-30 minutes three times a week
• Take an aspirin pill every day.

Conclusions

CVD isn't only a "man's disease." It is, without a doubt, the most serious illness killing women worldwide. Despite this, its significance in women is underestimated. As a result, a wider women's health agenda is required, one that integrates sexual and reproductive health with cardiovascular disease and other no communicable illnesses.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808501/

https://pubmed.ncbi.nlm.nih.gov/14631515/

https://pubmed.ncbi.nlm.nih.gov/23047015/

https://pubmed.ncbi.nlm.nih.gov/11140544/