Cardiovascular disease in women: differences compared to men

Cardiovascular diseases are not the exclusive heritage of man. In fact, stroke is the leading cause of female death in Spain. Nonetheless, there is a widespread idea that women have a lower risk of thrombosis. And this is partly so up to a certain age. However, once menopause is reached, the risks even out.

The explanation is fundamentally biological. due to the protective effect that female hormones have on our circulatory system during the woman’s fertile stage. In addition, this hormonal action delays the onset of high blood pressure, hypercholesterolemia or diabetes, which are known classic risk factors.

But, in addition to these classic risk factors, which can affect both sexes, there are others that are specific to the female sex. And its importance is beginning to be recognized more and more, even if it is not so familiar to us or given as much attention. They can precede the development of menopause by several years, hence their importance. These are phenomena that occur throughout a woman’s life, such as those that have to do with hormonal changes induced by pregnancy, or with specific diseases or more frequent in it.

we have to mention also psychosocial factors, which act as modulators of the previous ones. Like biological factors, they explain the differences that exist between men and women in the field of cardiovascular diseases. In the following article we are going to see why heart disease is far from being just a men’s thing.

Pregnancy, menopause and cardiovascular risk

Women who develop diabetes during pregnancy have a 7-fold increased risk of being diabetic throughout their lives. Similarly, hypertension during pregnancy, called preeclampsia, makes the appearance of later arterial hypertension 7-8 times more frequent.

Therefore, women with this type of disorder during pregnancy should subsequently undergo closer follow-up for early detection. In addition, we know that diabetes is particularly more damaging at a cardiovascular level for women, as is the case with smoking.

Repeated abortions and a history of premature births, when they are suspected to occur due to placental insufficiency, are also a marker of increased cardiovascular risk. probably because poor circulation at the level of the placenta is related to microcirculation problems at other levels. These women should be screened for certain prothrombotic factors, such as hyperhomocysteinemia or antiphospholipid syndrome.

Early menopause should be taken into account when counseling women about their cardiovascular risk. Particularly, when it occurs before the age of 40-45.

Early menopause increases cardiovascular risk by 50% and sometimes it is surgically induced, when due to certain diseases it is necessary to perform a hysterectomy and/or adnexectomy.

Most common diseases in women

There are more frequent diseases in women that increase their cardiovascular risk. Depression, anxiety and other mood disorders cause sustained stress that increases vascular damage through different mechanisms. Without forgetting that much of this damage is due to a worse lifestyle: they perform less physical exercise, have a higher consumption of toxic substances and a high rate of abandonment of the prescribed medication.

Another relevant pathology is breast cancer, which affects 1 in 8 women. As with other tumors, the risk of thrombosis increases. But also, there is cardiovascular damage mediated by the treatments that are used, such as chemotherapy agents that increase the risk of heart failure. Radiotherapy can also damage the heart, especially coronary lesions, with an effect that can take years to appear. This very frequent tumor has promoted cardio-oncology units, which are services that involve an oncologist and a cardiologist to reduce the impact of cancer treatments on cardiovascular health.

Autoimmune diseases, such as lupus or rheumatoid arthritis, are also more common. These processes produce a chronic proinflammatory state, that is, they are diseases that cause an increase in the inflammatory response at the vascular level. This inflammation translates into a higher risk of thrombotic events due to endothelial damage. When the endothelium, the layer that lines our blood vessels inside, does not work well because it is altered by an inflammatory response, circulation is impaired. This is because healthy endothelium promotes vasodilation, better blood circulation, and prevents platelet aggregation, thrombosis.

Recently, migraine with aura, more frequent in women, has been considered as aa disease to be taken into account to assess cardiovascular risk. In fact, in the presence of these migraines, it is recommended to avoid oral contraceptives, which are drugs with a recognized thrombotic risk, when they coexist with smoking or other conditions. This is so, because the presence of migraine also translates into a worse functioning of the blood circulation at the cerebral level.

Unique psychosocial aspects of women

Apart from the biological aspects mentioned, there are other very influential factors in the psychosocial sphere. From the social point of view, highlights the role of women as caregivers at the family level, postponing their health care. This factor has a negative influence, increasing the delay in requesting health care. On average, women seek care much later when she is having a heart attack, with adverse prognostic consequences.

This characteristic role of women worsens follow-up in consultations, as well as in cardiac rehabilitation programs. Cardiac rehabilitation has strong scientific evidence for improving the prognosis of heart failure, after suffering a heart attack or after heart surgery. However, it is underused in women for this reason, having a higher dropout rate than in men.

On the other hand, it is also known that women receive fewer heart transplants on average, fewer ventricular assist devices and fewer devices, such as implantable defibrillators or resynchronizers. The therapeutic approach is distorted by sex. Although this fact also occurs in the diagnosis. It has been seen that women with chest pain treated in the emergency department receive fewer invasive studies, such as catheterization, on average, than a man with the same characteristics.

In conclusion

Sex is a key modulating factor of cardiovascular diseases. Traditionally, men have a higher cardiovascular risk at an early age, but we must not forget that after menopause this risk is equal.

But it is that women also have a series of risk factors of their own, which enhance the classic ones and that must be taken into account when assessing their cardiovascular risk.

Nor should we forget that there are psychosocial factors that also influence women’s cardiovascular health. Some depend fundamentally on the role of women at the family level, but others derive from assistance aspects. Both in some and in others we have much to improve in health education.

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