Cardiovascular care in women represents a paradigm shift in modern cardiovascular medicine. Historically viewed as a 'male-centered' disease, cardiovascular disease (CVD) remains the leading cause of mortality globally in women.
Beyond traditional risk factors
Classic risk factors like hypertension, diabetes and dyslipidemia, though they affect both sexes, carry different risks in women.
A history of gestational diabetes, preeclampsia, gestational hypertension, preterm birth and low birth weight infants increases long-term ischemic heart disease and heart failure risk. Early menopause before the age of 40 removes the cardio-protective effects of oestrogen, causing atherosclerosis progression.
Similarly, polyendocrine metabolic ovarian syndrome (PMOS) may lead to insulin resistance, causing vascular risk. Autoimmune diseases like SLE and rheumatoid arthritis are more prevalent in women and inflammation causes accelerated atherosclerosis and endothelial dysfunction.
Impact of traditional risk factors
Type 2 diabetes mellitus causes a 3-fold increased risk of fatal Coronary Artery Disease (CAD) in women (compared to 2-fold in men), eliminating the premenopausal survival advantage. Hypertension thresholds are lower in women for causing vascular damage. Similarly, smoking and tobacco use are more potent drivers for myocardial infarction in women compared to men.
Variants of ischemic heart disease
Though Ischemic heart diseases are prevalent in both genders, women are more likely to present with non-obstructive variants like ischemia/infarction with non-obstructive coronary arteries, microvascular dysfunction, spontaneous coronary artery dissection and tako-tsubo or stress cardiomyopathy.
Atypical presentations
Though chest pain or angina remains the most frequent symptom of acute coronary syndrome in women, only 50 per cent of females experience the same. They have a much higher prevalence of angina equivalent, like dyspnea or profound fatigue, GI symptoms, jaw pain, giddiness or diaphoresis. This atypical presentation may lead to delayed presentation or prolonged 'symptom to balloon time'.
Some studies show that women who have CAD and a condition called heart failure with preserved ejection fraction (HFpEF) are less likely to receive all the necessary treatments according to medical guidelines compared to men. The reason could be attributed to the tendency of women to get more adverse reactions when taking some medications due to the way their bodies metabolise these drugs.
(The author is a cardiology consultant at Manipal Hospital, Sarjapur Road)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK
