Women and Cardiovascular Disease

Overview

Cardiovascular disease (CVD) is the number-one killer of women globally.1 Even though it is widely recognized that cardiovascular disease is the leading threat to women’s health, misconceptions still exist that cardiovascular disease is primarily a disease of middle-aged men.

CVD can impact women and men of any age and any nationality. Unfortunately, many women do not consider themselves at risk for CVD. This misconception, along with the fact that risk factors and symptoms of acute events often differ between women and men, leads to an imbalance in the assessment, diagnosis, treatment, and outcomes of cardiovascular disease in women.

What is Cardiovascular Disease?
Cardiovascular disease (CVD) is a term that encompasses a constellation of disorders affecting the heart and circulatory system. These conditions include coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, and deep vein thrombosis and pulmonary embolism.

Prevalence

Cardiovascular disease is the leading cause of death in women in every major developed country and most emerging economies.2
Globally, over 7 million women die every year due to cardiovascular diseases.1
In the United States, cardiovascular disease causes nearly one death per minute—almost 420,000 female deaths per year.3
52% of female deaths in Europe are from cardiovascular disease.4
In Latin America, cardiovascular disease-related deaths disproportionately affect women.5
Heart disease and stroke cause 43.9% of deaths in women in China.6

The Global Burden of Cardiovascular Disease in Women

Cardiovascular disease is the leading cause of death for women worldwide.7
One-third of deaths in women are due to cardiovascular disease.7
Each year, 8.6 million women around the globe die from heart disease and stroke.8
Heart disease and stroke kill more women than all cancers, tuberculosis, HIV/AIDS, and malaria combined.8

Prevention

Heart Disease Prevention—Guidelines for a Healthy Heart (10)

With the recognition that women face a greater risk of death due to cardiovascular disease, guidelines for heart-disease prevention for women have been drafted. An updated set of guidelines from the American Heart Association that focuses on long-term preventive strategies was published in 2011. Recommendations include:

Lifestyle changes, including smoking cessation and moderation in alcohol consumption
Increased physical activity, with at least 150 min/wk of moderate exercise, 75 min/wk of vigorous exercise, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity
Consumption of a diet rich in fruits and vegetables; whole-grain, high-fiber foods; and oily fish, with limited consumption of saturated fat, cholesterol, trans-fatty acids, sodium, and sugar
Weight control through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated to maintain or achieve an appropriate body weight
Maintenance of an optimal blood pressure of <120/80 mm Hg. Pharmacotherapy is indicated when blood pressure is ≥140/90 mm Hg (≥130/80 mm Hg in the setting of chronic kidney disease and diabetes mellitus)
Encouraging healthy lipid levels through lifestyle approaches: LDL-C <100 mg/dL, HDL-C >50 mg/dL, triglycerides <150 mg/dL, and non–HDL-C (total cholesterol minus HDL) <130 mg/dL. LDL-C–lowering drug therapy is recommended simultaneously with lifestyle therapy in women with CHD to achieve an LDL-C <100 mg/dL. In women >60 years of age and with an estimated CHD risk >10%, statins could be considered if hsCRP is >2 mg/dL after lifestyle modification and no acute inflammatory process is present.
Lifestyle and pharmacotherapy can be useful in women with diabetes mellitus to achieve an HbA1C <7% if this can be accomplished without significant hypoglycemia.
Regardless of the cardiovascular-disease 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.

Symptoms

Heart Attack Symptoms in Women

Differences in the Presentation of a Heart Attack
Knowing and acting on the heart-attack symptoms in women and men can mean the difference between life and death. Many women do not recognize the atypical symptoms of a heart attack that often are present in women, or they disregard them as symptoms of other non-life-threatening conditions. 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.

Heart-attack Symptoms in Women
The most common symptoms of a heart attack are-common in both women and men:15

Discomfort or pain in the chest
Discomfort or pain in the left shoulder, arms, elbows, back, or jaw

Other symptoms of heart attack that are often more common in women than in men include:16,17

- Shortness of breath or

- difficulty breathing
- Nausea or vomiting
- Lightheadedness
- Cold sweats

- Loss of appetite/heartburn
- Weakness or unusual/unexplained fatigue
- Heart flutters
- Cough

Solutions

Cardiovascular disease is largely preventable, and simple blood tests can help assess a person’s risk. Blood tests commonly used in risk assessment of cardiovascular disease.

DiaSino Infinosis™ FIA menu

cTnI

Myo

CK-MB

NT-proBNP

D-Dimer

HbA1c

DiaSino Porrima™ CLIA menu

cTnI

Myo

CK-MB

cTnI

Insulin

C-Petide

1. http://gamapserver.who.int/gho/interactive_charts/women_and_health/causes_death/ chart.html

2. Gholizadeh L, Davidson P. More similarities than differences: an international comparison of CVD mortality and risk factors in women. Health Care Women Int. 2008;29:3-22.

3. FACT SHEET: Cardiovascular Disease: Women’s No. 1 Health Threat. AHA/HPFS/1/2012; American Heart Association.

4. Nichols M, Townsend N, Scarborough P, Luengo-Fernandez R, Leal J, Gray A, Rayner M. European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.

5. Tejero, M.E. Cardiovascular disease in Latin American women. Nutrition, Metabolism & Cardiovascular Diseases. 2010;20:405-11.

6. World Heart Federation http://www.world-heart-federation.org/congress-and-events/world-congress-of-cardiology-scientific-sessions-2010/press/press-releases/detail/article/90-of-chinese women-are-unaware-that-heart-disease-and-stroke-are-their-number-one-killers/

7. World Health Organization http://www.who.int/gho/women_and_health/mortality/causes_death/
en/index.html

8. World Heart Federation http://www.world-heart-federation.org/fileadmin/user_upload/documents/Fact_sheets/2012/CVD_women.pdf

9. http://www.cadiresearch.org/topic/women/women-and-cad

10. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2011 update: A guideline from the American Heart Association. J Am Coll Cardiol. 2011 Mar 22; 57(12):1404-1423.

11. http://www.who.int/cardiovascular_diseases/en/cvd_atlas_12_women.pdf

12. http://circ.ahajournals.org/content/123/4/e18;accessed

13. http://www.cadiresearch.org/?page_id=867

14. FACT SHEET: Cardiovascular Disease: Women’s No. 1 Health Threat. AHA/HPFS/1/2012; American Heart Association.

15. http://www.who.int/mediacentre/factsheets/fs317/en/index.html

16. http://womenshealth.gov/heartattack/symptoms.cfm?q=know-the-symptoms

17. http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack /Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp

Women and Cardiovascular Disease