Protecting women from heart disease | Daily News

Protecting women from heart disease

Elderly women are more prone, compared to men
Young female smokers are more susceptible to cardiovascular heart diseases
Young female smokers are more susceptible to cardiovascular heart diseases

Cardiovascular disease (CVD) is still the leading cause of death in the world. Fatalities due to CVD exceed the number of deaths from all cancers combined.

According to the WHO, Coronary Heart Disease (CHD) is an acute or chronically-impaired performance of the heart caused by a reduction or complete interruption of blood supply to the cardiac muscle resulting from cholesterol and fat deposits (atherosclerosis) in coronary arteries. Atherosclerosis of the coronary arteries leads to plaque formation and narrowing of the cavities of the coronary arteries.

These processes manifest clinically as angina pectoris (chest pain on exertion), myocardial infarction (heart attack), heart failure, cardiac rhythm disturbance and sudden cardiac death. There is a significant difference in the incidence of CHD in women when compared to men.

CHD occurs less frequently in women than in men. However, with increasing age, this advantage gradually decreases. At the time when CHD develops in women, they are approximately 10 years older than men. Therefore, CHD in women is definitely a disease of elderly women.

The probability of dying from myocardial infarction is much higher for women than for men. The reason is that, at the time of the infarction, women are older and suffer from many other illnesses such as hypertension (high blood pressure), diabetes and hyperlipidaemia (high cholesterol and triglycerides).

The following risk factors are associated with the high prevalence of CHD both in men and women.

* Age

* Family history of CHD

* Smoking

* Hypertension

* Diabetes

* Hyperlipidaemia (high cholesterol and triglycerides)

The risk factors may have different relative importance in men and women. For example, diabetes and smoking carry a greater risk in women than in men. The risk factor that is unique in women is menopause. Natural menopause or any other cause of estrogen deprivation has been shown to have a significant increase in risk for coronary heart diseases.

As long as a woman does not consider CHD as a threat to her health, she will not try to change her lifestyle for risk modification and will not seek medical attention for symptoms.


Smoking is the most preventable cause of death due to CHD. Compared to men, women who smoke have a threefold increased risk of fatal and non-fatal coronary heart disease. In addition, women who smoke will get heart attacks at an earlier age than men. Smoking leads to an early menopause increasing further the risk of CHD.

Women experience more difficulty in quitting smoking. Research has proved that women more often smoke either to lose or maintain body weight or with no knowledge about the risk of CHD.

It is well known that elevated cholesterol levels are associated with high risk of CHD, independent of gender.

HDL level in women

Low HDL levels are associated with high risk for CHD in women. The risk of non-fatal heart attacks increases by 50 percent in women with a HDL value lower than

35mg/dl, in comparison with men with the same HDL level. The HDL level lowers after menopause.

During the childbearing years, women have significant low levels of LDL (bad cholesterol) than men, but after menopause, LDL levels exceed those seen in elderly men. Thus post-menopausal women have a more atherogenic lipid profile (cholesterol plaque formation), increasing cardiovascular events.

Diabetes mellitus

The risk of CHD in pre-menopausal diabetic women is identical to that of non-diabetic men. Furthermore, diabetes is a stronger CHD risk factor in women than in men. Mortality rates (death rates) for CHD are three to seven times higher for diabetic versus non-diabetic women. Diabetic women have a higher risk of re-infarction (second heart attack) and heart failure.


Before 45 years, hypertension (high blood pressure) is more common in men than in women. However, after 60 years, the age-associated rise in blood pressure is more pronounced in women than in men. Obesity, frequently associated with hypertension, is also strongly linked to the development of hypertension, especially in women. Medical treatment reduces the risk of coronary artery disease in them.


Obesity is defined on a Body Mass Index (BMI) above 25. The relative risk of myocardial infarction is reduced by 35 to 60 percent in women with normal BMI, lower than 25. In contrast, abdominal or central obesity (waist >hip ratio >0.8) is even a stronger risk factor for CHD in women than the BMI alone. Central obesity and a sedentary lifestyle are more common in women than in men, suggesting a higher risk for CHD.

Risk factors unique to women


Natural menopause or any other kind of estrogen(or oestrogen) deficiency is associated with a higher risk of CHD. The incidence of CHD is negligible in pre-menopausal women without any risk factor, but increases significantly after menopause; oestrogen was assumed to have a cardioprotective effect. Oestrogen replacement is connected with a decrease in many of the negative changes in risk profile associated with menopause.

Oral contraception

Combined (oestrogen and progesterone) oral contraception with high or medium oestrogen doses uniformly share an increased risk of myocardial infarction, particularly in cigarette-smoking women.

Diagnosis of CHD in women

Women have a high likelihood of atypical symptoms such as difficulty in breathing without pain, chest discomfort, indigestion, pain between shoulder blades or burning sensation behind the sternum. Atypical angina (atypical chest pain) is the most common in elderly women. In addition, women have a higher prevalence of chest pain during rest and the symptoms induced by emotional stress.

Prinzmetal angina or variant angina is caused by arterial spasms. This can occur in normal coronary arteries as well as plaque-burdened arteries. The right coronary artery is affected more frequently than the left. More frequently, women suffer from this type of vasospastic angina (chest pain due to arterial spasms). Young female smokers are affected in particular. This angina occurs predominantly at rest, with ECG changes.

Syndrome X

This is seen predominantly in women. More than 50 percent are pre-menopausal women. The underlying cause for this is cellular dysfunction and reduced arterial dilatation capacity in microcirculation (small vessels) in the heart. Long-term prognosis (life expectancy) is excellent.

Stress ECG

The stress ECG is limited in women. It is associated with a higher rate of false-positive results in women than in men.


Despite recent refinement in techniques in angioplasty and better adjunctive therapy, women continue to be at higher risk than men for complications after angioplasty and continue to have a higher in-hospital mortality regardless of the device used.

Acute myocardial infarction

Women develop myocardial infarction roughly 10 years before men; therefore, it is a disease of elderly women. After 75 years, more women die from myocardial infarction compared to men.

Silent myocardial infarction

Women have a higher possibility of silent myocardial infarctions(silent heart attack) than men. The reason remains unclear. Atypical symptoms tend to delay the visit to the hospital for diagnosis and treatment.

Thus, the following conclusions can be arrived:

* The increased incidence of risk factors for acute heart attacks is higher in older women than men.

* More often, women suffer from mild heart attacks compared to severe heart attacks.

* Women have an increased incidence of complications with acute heart attacks than men (eg., cardiogenic shock, heart failure, re-infarction, bleeding, stroke).

* Women have a high risk of cerebral bleeding (bleeding into the brain after a clot-dissolving injection is given for myocardial infarctions); therefore primary angioplasty is recommended. Primary angioplasty involves balloon dilatation and stenting immediately after hospital admission.

* Women have increased early mortality rates after heart attacks compared to men.

CABG surgery

Women undergoing Coronary Artery Bypass Graft (CABG) have a higher operative risk than men. This is attributed to older age, smaller body size, a high number of risk factors, especially diabetics. Most cases could be prevented if women seek medical attention earlier.


Despite the fact that oestrogen has multiple antiatherogenic effects (reduction of cholesterol and fat deposits), oestrogen replacement therapy (Hormone Replacement Therapy or HRT) is associated with an early increased risk of cardiovascular events. This is the prothrombotic (clot formation) effects of progestin. Therefore post-menopausal HRT should not be used for primary or secondary prevention of heart diseases. 


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