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.
It is thought that this difference is partially due to THE protective hormonal effects of estrogen as a woman’s risk of having a heart problem 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.
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 they present, and the types of complications they experience. There are also differences in the comprehensiveness of the medical care men and women receive. Along with the lack of general awareness of women’s cardiovascular disease (CVD) compared to that of men.
Estrogen has numerous effects on vascular tissue. It relaxes blood vessels, lowering blood pressure (pre-menopausal). It 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.
The main types of heart disease women are prone to are Coronary Heart Disease, Coronary Microvascular Disease, and Broken Heart syndrome.
Several types of disease are more common in women than in men: stroke, hypertension, endothelial dysfunction, and congestive heart failure. As the presentation of these diseases is often less symptomatic, both patient and doctors benefit from efforts to increase awareness and practice prevention to reduce cardiovascular disease.
While men and women have similar rates of hospitalisation, 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.
Many of the risk factors for cardiovascular disease are related to lifestyle influences such as diet, exercise, tobacco use, alcohol consumption, and also physical factors such as being overweight, psychosocial stress, and depression. 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.
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 improving the rates of basic assessment will improve CVD detection and prevention, but, 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.
The author is a Consultant Cardiologist at Zen Multi Specialty Hospital in Chembur, Mumbai.