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Monday, Feb. 24, 2020

How Heart Disease Affects Women

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Women are impacted significantly more than men

Nearly one in four individuals in the United States dies from heart disease. Although it is the leading cause of death for both men and women, heart disease kills more women than men, causing one in three deaths of women each year. According to the American Heart Association, only one in five women in the U.S. believe that heart disease is their greatest health threat. February is American Heart Month, which is a significant opportunity to bring awareness to this disease and the importance of heart health.

There are significant differences in heart disease prevention and treatment based on gender, age, ethnicity and socioeconomic status. The prevalence of myocardial infarction, or a heart attack, has increased among women between 35-50 years old compared to men of the same age. It is estimated that more than 30,000 women younger than 50 years of age are hospitalized following heart attacks each year in the United States. In contrast to males, women have a poorer prognosis, including increased prevalence of heart failure after a heart attack and significantly higher mortality rates. The more elevated risks of mortality and complications in women after heart attacks may be due to the under-representation of women in clinical trials, lack of gender-tailored pharmacological treatments, and perhaps a higher vulnerability of women compared to men to traditional and emerging risk factors. For example, epidemiological studies have recently shown that psychological stress is associated with higher rates of cardiovascular disease risk and increased health-care costs in women compared to age-matched men. Stress levels have been shown to correlate with delayed recovery, increased recurrence and increased mortality after heart attacks in women. Women have a unique vulnerability to the effects of stress compared to males. Studies show that women less than 50 years old have a significantly increased rate (three times higher) of mental stress-induced heart attacks compared to age-matched men.

Almost every single risk factor that causes heart disease has a higher prevalence in post-menopausal women than men. Although pre-menopausal women have lower risk and incidence of hypertension compared with agematched men, this advantage for women disappears after menopause. After 65 years of age, a higher percentage of women than men have hypertension, and this is likely to increase further with the continued aging of the female population.

Although there are several reasons for gender differences in blood pressure, the predominant explanation seems to be hormonal. Pre-menopausal hypertensive women with regular menstrual periods appear to have lower levels of female sex hormones compared to agematched women that do not have hypertension. While an equal number of men and women have diabetes, women with diabetes have a higher risk of heart disease and lower survival rates compared with men. Roughly 20 million women are obese in the United States, which is about four in every 10 women, amounting to five percent more than the U.S. men. Moreover, obesity in women can cause them to be more susceptible to Type 2 diabetes than men.

Women have higher resting heart rates than men, and differences in the electrical properties of women’s hearts cause them to have a higher chance of developing dangerous cardiac rhythm problems. Although more men develop an erratic heart rhythm in the top chambers of the heart, called atrial fibrillation, more women with this condition will suffer from a stroke. The association between atrial fibrillation and stroke is due to the formation of blood clots in the heart that can travel into the vessels leading to the brain and block blood flow. While blood thinners are the common therapy to prevent such stroke in patients with atrial fibrillation, that therapy can be a double-edged sword in women, since women have a higher risk of bleeding complications with the blood thinners.

Despite more women dying from cardiovascular causes every year compared to men and the established utility of invasive cardiac procedures that can alleviate symptoms and prevent death and heart attack, only 33 percent of these procedures are performed on women.

Even following a cardiac arrest, up to 25 percent fewer women receive lifesaving procedures compared to men. Moreover, women with heart disease who do receive these lifesaving procedures often experience delays in receiving treatment. This delay might partially explain why women who receive invasive procedures for blockages in the heart arteries have a higher risk of complications and death. Women have increased risk of death after bypass surgery procedures considered the best treatment for blocked heart arteries in specific patient populations.

Researchers around the world are focusing on finding the cause for these sex-based differences in cardiovascular diseases. Researchers at LSU Health Shreveport are working on identifying how gender affects heart function in models of heart attack, heart failure and atrial fibrillation, with the ultimate goal of identifying agents to treat heart disease in women specifically. However, for all of the above-mentioned reasons, the best way for women to have the best outcomes is to maintain heart health by adopting a healthy lifestyle.

Avoiding saturated and trans fats and consuming monounsaturated fats are key components of a healthy diet. In addition, at least 30 minutes of daily physical activity and maintaining a healthy weight are essential. Staying away from smoking and salty food is vital.

Paari Dominic, MD, is an assistant professor in the Department of Internal Medicine, Division of Cardiology at LSU Health Shreveport. He is also an assistant director of the Center for Cardiovascular Diseases and Sciences. Diana Cruz-Topete, PhD, is an assistant professor in the Department of Molecular and Cellular Physiology at LSU Health Shreveport.

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