Why is a cardiovascular disease more serious in women?

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Women should learn about their cardiovascular health as much as they do to prevent and detect breast cancer. Some statistics indicate that for every woman who dies from this type of cancer, there are 12 who die from heart disease or stroke, included in the set of cardiovascular diseases (CVD).

It is often said that women underestimate their cardiovascular risk, but in reality, the scientific community has underestimated it the most. And it is that the heart issues were focused on the male version, both in terms of preventive strategies, treating the disease, or participating in clinical trials. In recent decades, numerous initiatives have appeared to counteract this gender bias, and with the incorporation of the female factor into cardiovascular disease statistics, its remarkable prevalence has been seen. 

In Europe, one in five women dies from CVD, including coronary heart disease, heart failure and stroke. Cardiovascular disorders are the leading cause of death in the world in both men and women, but it has been shown that they are more severe and have a worse prognosis in women.

Towards the paradigm shift

For a decade, researchers have warned that the characteristics of the female sex can overlap important symptoms and risk factors. Since then, declarations have been made by international scientific societies to pay more attention to CVD in women, although the message does not fully penetrate either in daily medical practice or the women themselves.

“Cardiovascular disease in women should be a priority in national health strategies. Women make up more than 50% of the population. There is a long way to go to alleviate the inequities in diagnosis and treatment suffered by women with CVD.

None is comparable to the offensive launched several years ago by the American Heart Association and the American Stroke Association (AHA and ASA) to raise awareness of the risks of CVD in women. The deployment of a specific research network promoted by the Go Red for Women campaign, developed by five American universities, is already beginning to bear fruit.

The diagnostic delay

Research and clinical practice suggest that traditional diagnostic methods are not optimal for women, and heart disease should be treated from a gender perspective. For example, many women presenting to the emergency room with chest pain are not recognised as “heart pain” because it does not respond to the traditional pattern. This doubles the risk of coronary heart disease five years later and quadruples the risk of rehospitalisation and recurrent medical tests. A study published in 2019 concluded that being a woman increases the risk of dying from a heart attack by 18%.

“Continuing to believe that angina pectoris or myocardial infarction is a disease of men, even more so if the person suffering from the symptoms is a woman under 60 years of age, delays the diagnosis of CVD in women, especially in heart disease. Ischemic (coronary heart disease). It is why the relevant diagnostic tests are not done on women. Women tend to consult later than men when they have heart attack symptoms, “normally because they are more resilient and have more family obligations that they put before their care.”

In a study carried out in your hospital, it has been seen that women with myocardial infarction presented cardiogenic shock more frequently than men, which is the most severe degree of heart failure and had higher mortality than men. These differences were perpetuated between 2003 and 2015. “We also observed that women were less frequently admitted to specialised hospitals, with the capacity to perform angioplasty and with acute cardiac care units, and that this increased hospital mortality in women.

Different CVD risks in men and women   

Heart disease affects more men than women, although women’s risk increases after menopause and equals theirs. CVD generally develops in women between 7 and 10 years later than men.

Most cardiovascular risk factors are common to both genders, including age and unhealthy lifestyle, high blood pressure, high cholesterol, obesity, and poor dental health (which can lead to endocarditis ). Some research has found that, in addition to the female risk factor posed by pregnancy complications, the woman’s risk is increased by:

  • Diabetes.
  • smoking
  • Sedentary lifestyle.
  • Stress and depression.
  • Family history of early heart disease.

Diabetes has a more significant cardiovascular impact on women than on men. Diabetic women with a heart attack have twice the risk of dying than diabetic men.   

And regarding the clinical differentiation of symptoms in the event of myocardial infarction, “women have chest pain in 90% of cases, the same as men, but it is a pain that oppresses, that radiates to the back or between the shoulder blades, and may also radiate to the neck, jaws, wrists, or left upper limbs. The expert adds that this pain may be accompanied by dizziness, nausea and vomiting more frequently than in men and that in diabetic women, pain may not appear and is replaced by an intense feeling of shortness of breath.

It also warns that “in many cases, women go to the hospital late, even when the pain has already disappeared, so the myocardial infarction is established (it is already in a later phase) and presents signs of heart failure: dyspnea and palpitations”.

Distinctive symptoms of stroke in men and women 

Men and women share several symptoms when it comes to having a stroke:

  • Numbness or weakness in the face, arm or leg.
  • Difficulties speaking or understanding what is said to you.
  • Difficulty walking or lack of coordination.
  • Vision problems and severe headache with no apparent cause.

But there are other additional symptoms that women present, such as general weakness; disorientation or confusion, memory problems; fatigue, nausea, or vomiting.

In addition, women may be at increased risk of stroke due to:

  • Pregnancy with complications.
  • Preeclampsia (very high blood pressure during pregnancy, doubles stroke risk years later).
  •  Contraceptives.
  • Hormone replacement therapy (should not be used to prevent stroke in postmenopausal women).
  • Migraines with aura (mainly if the woman is a smoker and takes contraceptives).
  • Atrial fibrillation (increases the risk of stroke in women over 75 years of age by 20 per cent).