On the Friday the 29th of September it is World Heart Day, a global event where awareness of cardiovascular disease is raised. A heavy topic and maybe not top of your list whilst you are enjoying expat life. However, we feel it is important to help raise the awareness and also to highlight the differences between how men and women are impacted by heart disease, and the risks and associated symptoms.
Cardiovascular disease and, in particular, coronary heart disease, is one of the main causes of death in developed countries. Coronary heart disease is understood as one that causes lesions in the arteries that nourish the heart (coronary arteries) and manifests itself in the form of myocardial infarction or angina pectoris – also known as chest pain.
Cardiovascular diseases impact sexes differently, as it pertains to incidence, evolution and prognosis. Mortality from cardiovascular disease in European women under 75 years of age is around 40% compared to 38% in men of the same age. The prevalence of coronary heart disease in women is not well known, as there is a lack of comprehensive epidemiological data. This is because the major studies on this pathology have been carried out in the male population. What we do know is that cardiovascular diseases are, ahead of breast cancer, the leading cause of death amongst the female population in developed countries.
According to a recently published study, women are physiologically more protected against cardiovascular disease than men. The reason for this is not yet clear, but it seems to be due to two possible biological reasons:
- The first is due to female hormones: oestrogen protects women from the onset of cardiovascular disease until post-menopause. Thereafter, a series of physical and metabolic changes occur in women that lead to an increase in the incidence of classical risk factors (such as hypertension, diabetes, weight gain) and thus increase their risk of cardiovascular disease.
- Secondly, it has been shown that during pregnancy a series of changes occur in the anatomy and functioning of the heart (due to increased needs) that “train” it and would be responsible for reducing the cardiovascular risk to which women are exposed. In fact, new drugs based on female hormones are currently being investigated as a possible treatment for heart failure.
Women tend to be older than men when they suffer from cardiovascular disease, and this complicates their recovery. After the menopause, women have a worse prognosis than men (due to the loss of oestrogen), as they no longer receive the natural protection of oestrogen and, as a result, risk factors multiply.
Symptoms of cardiovascular disease in women
In terms of the difference in the presentation of symptoms, it has been found that in women there is a lower frequency of classic chest pain (radiating to the left arm) and when it does appear it is usually atypical. In addition, symptoms related to heart failure (such as shortness of breath or dyspnoea) are more frequent.
Risk factors and prevention
Cardiovascular risk factors are similar in men and women – smoking, sedentary lifestyle, high cholesterol, diabetes, hypertension and weight. However,there are some differences with respect to these generic factors. Preventative measures can be beneficial to both sexes:
- Physical activity: depending on their lifestyle, some women can be more often sedentary, if they don’t have time for sport for example.
- Smoking: In recent years there has been an increase in smoking in women, compared to a decrease in men, probably linked to social reasons.
- Diabetes and obesity: In general, being overweight and diabetic are more frequent issues faced by women, especially after the age of 55.
- Isolipaemia: From the age of 50 onwards, women have higher cholesterol than men.
- Arterial hypertension: The prevalence of arterial hypertension is higher in women from the age of 65 onwards.
Additionally, it is important to understand that there are certain risk factors linked to women that are not present in men:
- Oestrogens: The loss of oestrogens after menopause eliminates cardioprotective capacity.
- Breast cancer treatment: Some drugs used in the treatment of breast cancer increase the risk of cardiovascular disease.
- Appearance of high blood pressure during pregnancy.
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