Cardiovascular disease is the leading cause of death in women in Europe and worldwide with many women living with chronic cardiovascular disease. Similarly, in Ireland one in four women dies from heart disease or stroke every year, the same as men. Surprisingly very few women realise this or that their risk of dying of a heart attack or stroke is 6 times more likely than dying of breast cancer.
There are differences in the aetiology and sometimes the presentation of CVD in women leading to misdiagnoisis. For instance, younger women are more likely to present with myocardial infarction/ischaemia in the absence of obstructive coronary artery disease (MINOCA/INOCA), with coronary artery dissection (SCAD) or Takotsubo cardiomyopathy. Further more women are protected by their hormones until the menopause so may develop atherosclerotic disease a bit later than men. Together this has meant that historically the public feel that heart disease is a man’s disease. Research has shown that cardiovascular disease in women has been under recognised, under diagnosed and under treated in the past. This is only now starting to change, though there are still far fewer women enrolled in clinical trials. This lack of awareness has meant women delay seeking help, and their symptoms may not be recognised and diagnosed quickly by health professionals, all of which lead to delays in effective and often life-saving treatment. The lack of women’s involvement in clinical trials has limited our knowledge of the efficacy, safety, and correct dose of many therapies in women compared to men which has led to the underutilisation of preventative treatments and interventions for CVD in women. It is therefore important to remove barriers for women entering clinical trials and encourage their participation so we can better understand their specific risk factors and response to treatment.
The Irish Heart Foundation’s campaign ‘Her Heart Matters’ is a very important campaign trying to address these misconceptions and raise awareness of the signs and symptoms of a heart attack as 50% of women are unaware of these signs and symptoms. Though the commonest symptom remains chest pain sometimes radiating to the arms, they can be more vague in women, who may also be breathless and dizzy. Women also tend to have more nausea and may underplay their symptoms.
The traditional risk factors of hypertension, high cholesterol, a family history of premature IHD, a sedentary lifestyle and obesity, affect men and women equally.
However, diabetes in women increases the risk of developing cardiovascular disease more than men and may mean they are less likely to feel pain if they are having a heart attack.
Smoking increases the risk of cardiovascular disease in everyone but women who smoke have a much higher risk of heart disease than men, the risk increasing with the number of cigarettes smoked. The recent AMI audit confirmed smokers have a heart attack 9 years earlier than those who don’t smoke.
It’s also important to know there are sex specific risk factors. These include a premature menopause. The lack of oestrogen leads to stiffening of the coronary arteries and alters the lipid profile increasing cardiovascular risk.
Preeclampsia and gestational diabetes increase’s a women’s long term risk of developing CVD. Polycystic ovaries, inflammatory and autoimmune disorders may also increase the risk of heart disease. Psychosocial risk factors, socioeconomic depravation, poor health literacy and environmental risk factors also have a role in increasing risk.
The good news is 80% of premature cardiovascular disease is preventable.
In addition to managing the traditional risk factors by ensuring control of blood pressure, blood sugar and cholesterol, stopping smoking and modifying the diet, it is important to remember that physical activity is one of the greatest tools for prevention of cardiovascular disease, as well as improving mental health and menopause symptoms. A minimum of 150 minutes of moderate intensity activity a week divided into manageable and enjoyable sessions is recommended.
Stress is something else we all have in our lives but it’s important to manage it. For some it becomes negative, impacting on day to day lives. When we are stressed we are more likely to drink and smoke more and eat unhealthily.
This coupled with the release of cortisol, which raises blood glucose and adrenalin, raises the heart rate and blood pressure and can increase cardiovascular risk. Again, exercise has a role here as it releases tension and helps improve sleep. Staying connected to friends and family and your support network is important. Sometimes if things become overwhelming it’s worth talking to your GP and seeking professional help.
There has been a welcome focus around women’s health issues with the Governments Women’s Health Action Plan as phase 2 includes emphasis on improving cardiovascular health. Hopefully this will address some of these issues. We need to invest in research assessing women’s cardiovascular health, support more awareness raising activity and ensure educational activities for healthcare professionals to ensure they are better equipped to assess and treat specific risk factors and identify signs and symptoms of CVD in women.
Currently females are also under represented in the cardiology profession so we need to continue to increase the number of women working as cardiologists.
For more information see irishheart.ie
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