Knowing the Difference Can Save a Life
One of the recent episodes of AFMC TV covers the basics of heart disease. Today’s blog dives deeper and focuses on women’s cardiovascular health. In honor of national heart month, we’re looking at the differences in cardiovascular disease (the number one killer of women) and some resources providers can use to educate their patients and get involved.
Men and women have key differences in cardiovascular disease that providers should be aware of to educate and treat their patients properly. Until recently, women have been diagnosed and treated for cardiovascular disease the same way men have: with the same tests, procedures, and medications. The risk of heart disease in women is often underrepresented due to a misconception that women are more protected from heart disease. This misrepresentation often leads to less aggressive treatments for women and a lower representation of women in clinical trials, leading to less overall awareness of the key differences in diagnosing and treating women's cardiovascular disease. Let's take a look at some of the key differences.
There are key differences in cardiovascular disease in men and women; yet, until recently, women's cardiovascular health has somewhat faded into the background.
Just like men and women display differences in their anatomy and physiology, they also have different cardiovascular systems. Women have smaller hearts and narrower blood vessels than men do. Because of this biological difference, symptoms of cardiovascular disease present and progress differently in women.
Cholesterol buildup occurs in a different area of a woman's body than a man's. While men typically develop plaque buildup in the larger arteries that supply blood to the heart, women have plaque build up in the heart's smallest blood vessels. Women who experience this have small vessel heart disease or coronary microvascular disease.
Women may also develop diseases that men don't have that often present symptoms similar to a heart attack, causing some clinicians to treat women for a heart attack incorrectly. Women are more likely to experience a coronary spasm, where a blood vessel clamps down and mimics a heart attack; a coronary dissection, which is a tear in the wall of a blood vessel; or takotsubo cardiomyopathy, an inflammatory response that causes the heart to enlarge after stress (typically referred to as "broken heart syndrome").
Exposure to estrogen delays atherosclerosis (buildup of cholesterol) in women. In fact, before menopause, the risk of cardiovascular disease in women is low due to the amount of estrogen in their bodies. Estrogen regulates several metabolic factors, such as lipids, inflammatory markers, and the coagulant system in the body. After menopause, women typically begin to experience a buildup of plaque in their blood vessels due to a loss of control over anticoagulant systems in the body.
At younger ages, women experience more harmful consequences from smoking than men. Women who smoke have a 25% higher risk of developing cardiovascular disease than men who smoke. According to an article in the Netherlands Heart Journal, smoking in young premenopausal women causes a deterioration of the systems that regulate blood pressure in the body, leading to increased blood pressure and more prevalence for diabetes (one of the leading risk factors of cardiovascular disease). Due to a common increase in body weight after menopause, more women are at increased risk of obesity than men. This increased risk of obesity also correlates with an increase in the prevalence of type 2 diabetes. Women with diabetes are at greater risk of cardiovascular disease than their male counterparts. This may be largely due to smaller coronary blood vessel size in women and often less aggressive treatment of diabetes in women.
Women who smoke have a 25% higher risk of developing cardiovascular disease than men who smoke. Smoking causes deterioration of systems that regulate blood pressure in the body, leading to high blood pressure and a higher prevalence of diabetes.
Other Key Differences
A woman’s reproductive history may affect her risk of developing cardiovascular disease. A woman may develop certain diseases during pregnancy that may increase her risk of future cardiovascular complications. Approximately five to eight percent of pregnancies are affected by preeclampsia, which causes high blood pressure and critical changes to a mother’s kidney, liver, and blood-clotting systems. During pregnancy, a mother may also develop gestational diabetes. Placental hormones cause high blood sugar levels during pregnancy, leaving the mother with a higher risk of developing type 2 diabetes later in life. According to a 2016 study by Brigham Health, women age 40 or younger who have endometriosis are three times more likely to develop a heart attack, chest pain, or blocked arteries compared to women without endometriosis in the same age group. Because the symptoms of conditions or diseases that mothers develop during pregnancy often do not present until a few weeks after pregnancy, clinicians may overlook some of these disorders. It's important that providers know the warning signs and symptoms and continue to educate themselves on the types of cardiovascular conditions that can occur during pregnancy.
Diagnoses and Treatment
The medical community has a weaker understanding of women’s cardiovascular health. Until recently, many clinicians diagnosed and treated women for cardiovascular disease the same way they diagnosed and treated men. For example, if a clinician suspects a man or woman has had a heart attack, they may receive a cardiac troponin (cTn) test, which measures troponin levels in the body. When the heart cells are injured or inflamed, they release troponin into the blood, signaling that the heart isn’t getting enough oxygen. Cardiac catheterization, the primary method used to diagnose a heart attack, looks for blockage in large arteries. Because clotting usually occurs in the smaller arteries of women, this test may not be effective at diagnosing cardiovascular disease in women. To properly diagnose women for cardiovascular disease, clinicians may recommend women get a cardiac MRI to identify inflammation or other imaging to look inside the blood vessels of the heart.
Engaging with Resources
It is essential that providers educate themselves on the resources available for women to understand their risk of cardiovascular disease. Many resources, like the Go Red for Women initiative by the American Heart Association, are dedicated hubs for managing heart complications. Go Red for Women explains ways to manage high blood pressure and cardiovascular disease at any stage of life, including during pregnancy and menopause. This initiative allows clinicians to see the latest research, hear testimonials from real women, and even get involved in the community. Clinicians can participate in lunch-and-learns, take CPR training, donate to the cause, and even participate in research for cardiovascular disease in women. Regardless of how they participate, clinicians have a new avenue they can explore to assist their patients with cardiovascular disease. Directing women of any age to these types of resources is a great way to get started.