10 February 2020

We already highlighted in previous newsletters the specificities of cardiovascular disease (CVD) in women, which continues to be the leading cause of death among women in the world, accounting for ≈1 of every 3 female deaths.

Awareness of CVD as the primary cause of mortality in women has been slowly increasing over years. However, unique aspects of CVD in women have contributed to less aggressive lifestyle and medical preventive interventions.

Biological variances among women and men may be related to sex differences (chromosomes and hormones). In contrast, they may be also related to gender differences (like behaviors, environment, lifestyle and nutrition).

CVD in women can include: atherosclerotic obstruction by a plaque, coronary microvascular dysfunction (not visible on routine angiogram), spontaneous coronary artery dissection, atherosclerotic plaque erosion with subsequent thrombus formation, and stress-induced cardiomyopathy (Broken Heart Syndrome). Women with heart failure are twice more likely than men to develop a special entity which is heart failure with preserved contractile function of the heart. 

Among risk factors are: aging, hypertension, diabetes, dyslipidemia, smoking, obesity, and physical inactivity. However, this excess risk is typically not observed before menopause

However, there are emerging, nontraditional risk factors. They include: pregnancy-related disorders (hypertension and cardiomyopathy), breast cancer treatments, radiotherapy, autoimmune diseases, and depression. These women are candidates for long-term cardiac surveillance.

Recommendations:

Lifestyle modification: women can substantially reduce their risk of coronary events by not smoking, maintaining healthy body weight (BMI <25>

Aspirin and statin: Overall, there is a very modest improvement in cardiovascular events with low-dose aspirin. The use of statins and aspirin in primary prevention may rely on the calculation of a 10-year risk of CV events by a specific score.

Hormone replacement therapy:

Since the mid-2000s, there is a marked decline in the use of hormone replacement worldwide. Overall, hormone therapy should not be prescribed for the express purpose of preventing CVD.

In Conclusion:

Women represent 51% of the world’s population, and it is time to address their cardiovascular disease in a specific and dedicated manner.

Antoine Sarkis, MD, FESC, FACC
Professor of Cardiology, Saint Joseph University & Hotel Dieu de France Hospital, Beirut, Lebanon
Immediate Past President of the Lebanese Society of Cardiology.
Yaduna Board of Trustees and Board of Director