Cardiovascular diseases are leading cause of death in women. Though incidence in men in 3-4 times higher, after 75 yrs women form the majority of patients with CVD. On an average CVD develops 10 years later in women, but mortality rate is higher in women (51% versus 42%).
CVD differs from men in few ways such as presentation, Risk Factors & Treatment strategies, and response to it.
Heart attack symptoms for women:
The most common heart attack symptom in women is the same as in men — some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes.
But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe heart attack pain as pressure or tightness. And it’s possible to have a heart attack without chest pain.
Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:
- Neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort
- Shortness of breath
- Pain in one or both arms
- Nausea or vomiting
- Sweating
- Lightheadedness or dizziness
- Unusual fatigue
- Heartburn (indigestion)
These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.
Compared with men, women tend to have symptoms more often when resting, or even when asleep Emotional stress can play a role in triggering heart attack symptoms in women.
Because women’s heart attack symptoms can differ from men’s, women might be diagnosed less often with heart disease than are men. Women are more likely than men to have a heart attack with no severe blockage in an artery (nonobstructive coronary artery disease).
Heart disease risk factors for women
Several traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — affect both women and men. But other factors may play a bigger role in the development of heart disease in women.
Some female specific risk factors play a role in development of CVD. Reproductive, hormonal & pregnancy related factors dispose to endothelial dysfunction ( damage to inner layer of blood vessels).
These include,
- Genetic predisposition.
- Early / late menarche
- Migraine during teens
- Reproductive disorders during adolescence
- PCOD
- Early menopause
- Presence of other disease such as rheumatic arthritis, thyroid disorders which are more common in women.
Heart disease treatment in women
In general, heart disease treatment in women and in men is similar. It can include medications, angioplasty and stenting, or coronary bypass surgery.
Some noted differences in heart disease treatment among men and women are:
- Women are less likely to be treated with aspirin and statins to prevent future heart attacks than are men. However, studies show the benefits are similar in both groups.
- Women are less likely than men to have coronary bypass surgery, perhaps because women have less obstructive disease or smaller arteries with more small vessel disease.
- Cardiac rehabilitation can improve health and aid recovery from heart disease. However, women are less likely to be referred for cardiac rehabilitation than men are.
Conclusion
CVD in women is under-recognized & under treated in clinical practice due to many reasons. There is a need for awareness about CVD among women as the natural history of CVD is different in women than in men. Women are protected from CVD due to estrogen, but post menopause the risk is higher than men.
Awareness and good diagnostic tools are necessary to evaluate the different aspects & for early detection of CVD in women. Management of risk factors and optimal treatment of underlying conditions can reduce the risk of CVD in women.
