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Women and Heart Disease: An Affair of the Heart
While there has been a decrease in the incidence of heart disease in men over the last 20 years, statistics indicate an increase in the number of women suffering from heart disease.1
Educational opportunity - Women and Heart Disease
Prevalence
- Globally, nearly 8.6 million women die every year due to cardiovascular diseases.2
- In the United States, cardiovascular disease is the number one killer among women and a leading cause of disability.3
- African-American, Hispanic-American, and Latin-American women are at a greater risk for developing heart disease compared to Caucasian women.4
- In the US, among women experiencing sudden death due to CHD, 64% had no previous symptoms.5
- Nearly 43% of all American women aged 40 years and above die within five years after experiencing their first heart attack.5
- Prevalence of CVD among women is particularly high following menopause.6
Getting to the Heart of the Matter: The Gender Factor in Heart disease
Heart disease in women has several unique differences in its presentation and outcome in comparison to men.
- Although heart attack is seen in both sexes, the rate of survival is lower in women.4
- The death rate within one year of a heart attack is higher among women compared to men (42% vs. 24%).1
- More women aged 40 years and older die within a year of the first episode of heart attack compared to men (23% vs. 18%).5
- In patients dying of acute myocardial infarction, the prevalence of plaque erosion, an important substrate for coronary thrombosis, is significantly higher in women than men.8
- High levels of triglycerides confer a greater risk of heart attack in women than men.
- Men and women differ in their response to thrombolysis. Women have higher levels of procoagulant factors such as factor VII and plasminogen activator inhibitor, which may result in greater resistance to thrombolytic therapy.9
Gender-Specific Risk Factors for Heart Disease in Women
While obesity, hypertension, diabetes, and hypercholesterolemia have been listed as traditional risk factors for CVD in both sexes, several specific factors contribute to the etiopathogenesis of heart disease in women.
- Heredity: A woman is more likely to develop heart disease if her mother or sister has a heart attack before 65 years of age, or if her father or brother has suffered an attack before the age of 55 years.4
- Marital Stress: Marital pressures increase the risk of coronary events in women.
- Hormones: Hormone replacement therapy (HRT) can increase the risk of heart attack and stroke.4
- Smoking: Women smokers on birth control pills are at a higher risk of heart attack and stroke compared to non smokers.4
Gender-Specific Differences in the Presentation of a Heart Attack
The symptoms of a heart attack may vary greatly from person to person, with some significant differences in presentation between men and women. While both sexes may have the typical pain, pressure, or discomfort in the chest, women tend to experience these less often than men, and women commonly present with symptoms other than chest pain.
Symptoms of a Heart Attack in Women
| Most common symptoms (common in both men and women)6 | Frequent symptoms (more common in women)4 | Less common symptoms (more common in women)4 |
|---|---|---|
| Discomfort or pain in the chest | Shortness of breath or difficulty in breathing | Loss of appetite/ heartburn |
| Discomfort or pain in the left should and arm, back, or jaw | Nausea or vomiting | Weakness or tiredness |
| Light-headedness | Heart flutters | |
| Cold sweats | Cough |
AHA Guidelines for a Healthy Heart10
With the recognition that women face a greater risk of death due to heart diseases, the American Heart Association (AHA) published a set of updated guidelines for preventing cardiovascular disease in women in the year 2007, emphasizing the need to focus on long-term strategies for the prevention of CVD.
The guidelines form a paradigm for risk assessment and management based on risk factors, family history, and the Framingham risk score. The recommendations include:
- Lifestyle changes, including moderation in alcohol consumption and weight control
- Encouraging women to quit smoking with the help of counseling, nicotine replacement or other forms of smoking cessation therapies
- Increased physical activity with regular exercise, including brisk walking for a minimum of 60-90 minutes, preferably on all days of the week
- Emphasis on salt restriction and incorporation of more fresh fruits and vegetables in the diet
- Consumption of low-fat dairy products and restriction of saturated fat consumption to less than 7% of the total calorie intake
- Omega-3 fatty acid intake in the form of supplements or through the consumption of oily fish at least twice a week. Capsule supplement of 850–1000 mg EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in women with heart disease, and 2-4 g EPA and DHA in women with high triglycerides
- Selective estrogen receptor modulators (SERMs) and hormone replacement therapy (HRT) are NOT recommended for the prevention of heart disease in women.
- Regardless of the CVD status, the routine use of low-dose aspirin in women 65 years or older needs to be considered only if benefits are likely to outweigh risks
- Increased aspirin dosage, from 162 mg to 325 mg per day, is recommended in women with high risk for CVD
- LDL cholesterol reduction to less than 70 mg/dL with cholesterol-lowering drug therapy to be considered in women with very high risk for CVD.
References:
1. National Women's Health Information Center Heart Disease. Fact Sheet. http://www.4woman.gov/hearttruth/pdf/womheart.pdf. Accessed December 2008.
2. World Health Organization. WHO publishes results of largest-ever global collaboration on heart disease. http://www.who.int/mediacentre/news/releases/2003/pr72/en/. Accessed December 2008.
3. Medline Plus. Heart Disease in Women. http://www.nlm.nih.gov/medlineplus/heartdiseaseinwomen.html. Accessed January 2009.
4. National Women's Health Information Center Heart Disease. Frequently Asked Questions. http://www.4woman.gov/faq/heart-disease.cfm. Accessed December 2008
5. American Heart Association. Women and Cardiovascular Diseases - Statistics. http://www.americanheart.org/downloadable/heart/1199816973854FS10WM08.pdf.
Accessed December 2008.
6. World Health Organization. Cardiovascular Diseases. http://www.who.int/cardiovascular_diseases/en/. Accessed December 2008.
7. American Heart Association. Women, Heart Disease and Stroke. http://www.americanheart.org/presenter.jhtml?identifier=4786. Accessed December 2008.
8. Arbustini E, et al. Heart. 1999;82:269-272.
http://heart.bmj.com/cgi/content/abstract/82/3/269
9. Elkind MS, et al. Neurology. 2007;68:842-8. http://www.ncbi.nlm.nih.gov/pubmed/17353472?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_Discovery Panel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
10. American Heart Association. Updated guidelines advise focusing on women's lifetime heart risk. http://www.americanheart.org/presenter.jhtml?identifier=3045524. Accessed December 2008.
