CardyFit 9 Heart Disease in Women
CardyFit 9 Heart Disease in Women

Heart Disease in Women

Heart disease is often seen as a “mans disease”, but it is the leading cause of death in women worldwide.

Heart Disease

How heart disease manifests differently in women

Heart disease has long been perceived as a health issue primarily affecting men, which for long has undermined the fact that it is the leading cause of death among women worldwide. Despite this, women’s experience with heart disease is different compared to men, characterized by unique risk factors, atypical symptoms and often worse outcomes. While men are more likely to develop heart disease at a younger age, women on the other hand are subject to a significant increase in risk post-menopause due to hormonal changes, pregnancy and other sex-specific factors. 

Moreover, the symptoms of heart disease for women are more subtle and less recognizable compared to those in men, leading to delays in diagnosis and treatment. Historically, research has been primarily focused on men, as a result this has led many women being underdiagnosed and undertreated. As awareness grows about sex differences, it is necessary to develop new diagnostic and prevention techniques tailored to women. 

Underrepresentation of women in CVD trials 

In cardiovascular disease trials, women have been underrepresented. One study found that in 740 various cardiovascular disease trials conducted between 2010-2017, involving 862,652 adults, women made up only 38.2% of participants [1]. The underrepresentation in trials is concerning because it means that results may not accurately reflect how women respond to treatment or how the diseases is diagnosed. As a result, the medical decisions and treatment guidelines may be less effective for women, as the data from the trials is primarily based on men [1]. It is important to address the sex differences so that women can receive the proper care for their physiological needs. 

Risk factors unique to women  

Womens risk of heart disease increases later in life as compared to men, with menopause being one contributing factor. Before menopause, women typically have higher levels of good HDL cholesterol and lower levels of bad LDL cholesterol [2].  However, during peri–menopause and post–menopause, HDL cholesterol drops while LDL cholesterol rises [2]. A contributing factor is due to a decline in estrogen levels. One of the main forms of estrogen, 17-beta-estradiol, helps increase HDL, lowers LDL and helps support heart health by increasing angiogenesis and vasodilation [2, 3]. The drop in estrogen during menopause increases the risk of cardiovascular disease. As all women experience menopause, their risk of cardiovascular disease increases as they age. 

Peripartum cardiomyopathy (PPCM) is a form of heart failure which is not well known among women. It occurs in pregnant women on the last trimester or within the first six months after delivery and is characterized by a weakening of the heart muscles [4]. The symptoms of PPCM are similar to those of pregnancy, making it difficult to diagnose. The cause of PPCM is not well defined, but there are many possible factors such as the increased demand on the heart during pregnancy. Current data about the occurrence of PPCM is not very accurate because many cases are not reported, and many women do not know they have PPCM. Despite this underreporting, it’s known that Black women account for 40% of reported PPCM cases in the United States [5]. More studies are needed to better understand PPCM, and it is important that women are made aware of this disease so they can seek proper treatment. 

Adverse pregnancy outcomes (APO’s), such as preeclampsia and preterm birth, are becoming increasingly recognized as significant risk factors for heart disease in women. Not only do these conditions affect pregnancy but they also cause long-term implications for women’s cardiovascular health. Preeclampsia is a condition that causes high blood pressure during pregnancy. There is abundant evidence showing that women with preeclampsia  are at a risk of developing chronic hypertension later in life [6]. In a meta-analysis of 43 studies for hypertension, data indicates that within 15 years, 20% of women who experienced preeclampsia went on to develop hypertension [6]. Similarly, women with pregnancy loss have increased risk of blood pressure or hypertension, with risk being higher in recurring pregnancy loss [6]. These findings show the importance of cardiovascular monitoring for women with APO’s to ensure they receive appropriate treatment and reduce their risk of developing cardiovascular disease later in life. 

Atypical symptoms 

During a myocardial infarction (Heart Attack), women often experience atypical symptoms compared to men. While both men and women experience chest pain it is more common in men [7]. Aside from chest pain there are symptoms more prominent in women such as dizziness, sweating, shortness of breath, vomiting, palpitation, fainting, back pain and fatigue [7]. Chest pain is often a key reason individuals seek medical attention, but because women are more likely to experience these atypical symptoms, they may delay seeking medical care. Recognizing these atypical symptoms in women is very important for them to receiving timely and appropriate treatment. 

Worse outcomes after myocardial infarction 

Women who have suffered a myocardial infarction have worse outcomes compared to men. A study of nearly 2000 patients who had a myocardial infarction in Olmsted County, Minnesota, from 2000 to 2012 found that women had a higher risk of negative outcomes than men [8]. They had a 30% increase chance in recurring myocardial infarction [8]. These results highlight the need for more extensive research to clarify why women have an increased chance in recurring myocardial infarction compared to men and to develop treatments to improve outcomes for women. 

The importance of awareness in heart disease for women 

Heart disease shows up differently in women compared to men. Women experience different risk factors, atypical symptoms and often worse outcomes. From the impact of menopause and adverse pregnancy outcomes to the underrepresentation in clinical trials, heart disease is distinct and a significant problem in women. It is necessary to raise awareness and understanding of sex-specific differences. Increasing awareness not only among the public but also healthcare providers will lead to better diagnosis, treatment and prevention strategies for women. 

Participating in Research Goes Red | Go Red for Women 

Participating in research and contributing to women’s heart health through the American Heart Association’s Research Goes Red can be one way to make an impact. Learn more by visiting Research Goes Red | Go Red for Women 

References

  1. Tobb, Kardie et al. “Underrepresentation of women in cardiovascular trials- it is time to shatter this glass ceiling.” American heart journal plus : cardiology research and practice vol. 13 100109. 5 Mar. 2022, doi:10.1016/j.ahjo.2022.100109 
  2. Wizemann, Theresa M., and Mary-Lou Pardue, editors. Exploring the Biological Contributions to Human Health: Does Sex Matter? Institute of Medicine (US) Committee on Understanding the Biology of Sex and Gender Differences, National Academies Press, 2001, https://www.ncbi.nlm.nih.gov/books/NBK222292/. 
  3. Ryczkowska, Kamila et al. “Menopause and women’s cardiovascular health: is it really an obvious relationship?.” Archives of medical science : AMS vol. 19,2 458-466. 10 Dec. 2022, doi:10.5114/aoms/157308 
  4. Iorgoveanu, Corina et al. “Peripartum cardiomyopathy: a review.” Heart failure reviews vol. 26,6 (2021): 1287-1296. doi:10.1007/s10741-020-10061-x 
  5. Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jan 21;75(2):207-221. doi: 10.1016/j.jacc.2019.11.014. PMID: 31948651. 
  6. Parikh NI, Gonzalez JM, Anderson CAM, Judd SE, Rexrode KM, Hlatky MA, Gunderson EP, Stuart JJ, Vaidya D; American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association. Circulation. 2021 May 4;143(18):e902-e916. doi: 10.1161/CIR.0000000000000961. Epub 2021 Mar 29. PMID: 33779213. 
  7. Joseph, Neethu Maria et al. “Atypical Manifestations of Women Presenting with Myocardial Infarction at Tertiary Health Care Center: An Analytical Study.” Journal of mid-life health vol. 12,3 (2021): 219-224. doi:10.4103/jmh.JMH_20_20 
  8. Asleh, Rabea et al. “Sex Differences in Outcomes After Myocardial Infarction in the Community.” The American journal of medicine vol. 134,1 (2021): 114-121. doi:10.1016/j.amjmed.2020.05.040 

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