Women-specific risk factors of cardiovascular disease

Women-specific risk factors of cardiovascular disease

According to the Australian Institute of Health and Welfare, cardiovascular disease (CVD) is the cause of almost one-third of all deaths among women.

Published in June, 2019 the report found that over 500,000 Australian women have one or more kinds of heart, stroke or valvular diseases.

The report also found around 61 women per day had an acute coronary event (unstable angina or heart attack) in 2016. In 2017-18, approximately 37,000 women suffered from heart failure and 4.8% of women had either a heart, stroke or vascular disease.

Certain aspects of CVD prevention and treatment are unique to women and these gender differences are finally receiving more attention.

The report found that these were the biggest women-specific risk factors:

  • A greater risk of heart attack than men when it is associated with risk factors such as smoking, high blood pressure and diabetes.
  • Female smokers have a 25% increased risk of heart attack.
  • Women who smoke and take the oral contraceptive pill increase their risk of clots and heart disease.
  • Diabetic women are 4.3 times more likely to have a heart attack vs only 2.7 times for diabetic men.
  • Female heart attack patients are more affected by anxiety and depression than men.
  • Pregnancy complications such as pre-eclampsia and gestational diabetes increase heart disease risk.
  • Post-menopausal women have a higher incidence of CVD, because it’s thought that estrogen plays a role in heart disease prevention.
  • While risk factor rates such as smoking and drinking have declined, overweight and obesity has trended upwards.

Risk factors related directly to female hormones include pregnancy, breast cancer and menopause.

Pregnancy

The physical changes the body undergoes places extra pressure on the heart. The heart’s increased cardiac output can lead to CVD such as peripartium cardiomyopathy (PPCM), spontaneous coronary artery dissection (SCAD) and arrhythmias, which is also known as an abnormal heart beat.

Then there are pregnancy risk factors such as either pre-eclampsia, gestational hypertension and gestational diabetes, which can also contribute to CVD.

Pregnant women who had syncopal episodes (fainting), especially during the first trimester, also have increased risk of cardiac arrhythmia.

On the plus side, a March 2019 report by Binh et al published in the American Heart Association report by found “breastfeeding is associated with lower maternal risk of CVD hospitalization and mortality in middle-aged and older Australian women (and) may offer long-term maternal cardiovascular health benefit.”

Breast cancer

Patients who required radiotherapy may have incidentally exposed the heart to radiation, increasing the subsequent risk of heart disease. A report published in the Journal of the American Heart Association found “the increase is proportional to the mean dose to the heart, beginning within a few years after exposure, and continuing for at least 20 years.”

A study found women who received radiation on their left breast had higher rates of coronary artery disease vs those who had their right breast irradiated. Valvular and cardiomyopathic issues are can also be induced by radiation.

Breast cancer patients who go into early menopause (aged <40 years), due to drugs such as Tamoxifen which block estrogen receptors or have their ovaries removed if they have the BRACA gene, have an increased risk of CVD.

Menopause

Anecdotally, CVD rises in women post-menopause and it was believed that estrogen protects the heart, which is why there is a lower incidence of CVD in premenopausal women. But a report published in the Journal of the American Heart Association found that this wasn’t the case.

While estrogen can have a positive effect on the inner layer of the artery, helping it expand to keep blood flowing as it should, Dr Nieca Goldberg, a cardiologist and an American Heart Association volunteer, told the site that menopause does not cause heart disease. It’s the risk factors that increase during menopause – blood pressure rises, LDL cholesterol increases – that may be culpable.

“Menopause isn’t a disease. It’s a natural phase of a woman’s life cycle. It’s important for women, as they approach menopause, to really take stock of their health,” Dr. Goldberg told the American Heart Association.

Resources

AIHW study
https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/cardiovascular-disease-in-women/contents/table-of-contents

Cardiovascular disease in women
https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.116.307547

Menopause and heart disease
https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/menopause-and-heart-disease