Women and Heart Disease

• Heart disease affects women approximately 10 years later than men, possibly due to the protective effect of estrogen.¹ A woman’s risk of a heart attack increases steeply after menopause, when her LDL-C and triglyceride levels begin to increase and her good cholesterol (HDL-C) level begins to fall.

• After menopause, women’s cholesterol levels are, on average, higher than those of men of about the same age.¹

• Most women having a heart attack do not experience typical chest pain symptoms.

• Younger women who have a heart attack have higher mortality than men of the same age, despiteless severe coronary narrowing, smaller heart attacks, and more preservedsystolic function.^{2, 3}

• The syndrome of chest pain without obstructive CAD (coronary artery disease)is distinctly more common in women than in men. Among women, chest pain symptoms and disability donot correlate with severity of coronary narrowing.¹

• Possible explanations include: abnormalities in coronary vascular structure and function, positive remodeling (compensatoryvessel enlargement), coronary endothelial dysfunction leading to vasoconstriction,and microvascular disease.

• Women with established or suspected CAD have lower plaqueburden than men.² However women have more diffused atherosclerosis (plaque build up along the entire artery).

• Despite having more symptomsand physical limitations,women have less obstructive CAD than men along the entire spectrum of acute coronarysyndromes (ACS).¹

• Young  or middle-aged (whom one wouldexpect to be most advantaged for coronary disease risk), show higher rates of adverse outcomes, complications, and disability after heart attack or ACS comparedwith men.²

• A less aggressive clinical treatment of women with CAD relative to men has been documented for years,with a tendency to refer less often for coronary angiogram.

• Women who smoke are at increased risk of developing hypertension.¹ High-risk women have 7-20 fold heart attack risk than optimal-risk women (see CVD risk classification in women).¹ Black women have the highest mortality and is similar to that of white men.⁴

• Women who have had gestational diabetes, recurrent miscarriages, pregnancy induced hypertension or preeclampsia, have a higher risk of having a heart attack at a younger age than those who have not.¹

• Key questions remain about why women are protectedfrom CVD, why this protection is restrictedto the coronary system, and why this protection ends whenwomen have diabetes or heart attack.^{1, 6}

• Women with depression or diabetes have double the CVD (cardiovascular disease) mortality, which increases to 5-fold when both are present.⁵ (see diabetes and women)

Sources

1. 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. Mar 22 2011;57(12):1404-1423.

2. Vaccarino V. Ischemic heart disease in women: many questions, few facts. Circ Cardiovasc Qual Outcomes. Mar 2010;3(2):111-115.

3. Pilote L, Dasgupta K, Guru V, et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ. Mar 13 2007;176(6):S1-44.

4. American Heart Association. Heart and Stroke Statistical Update2011.

5. Pan A, Lucas M, Sun Q, et al. Increased mortality risk in women with depression and diabetes mellitus. Arch Gen Psychiatry. Jan 2011;68(1):42-50.

6. Stangl V, Baumann G, Stangl K. Coronary atherogenic risk factors in women. Eur Heart J. Nov 2002;23(22):1738-1752.