Cardiovascular disease (CVD) is the leading cause of death in women worldwide, highlighting the need for greater awareness and research into sex and gender differences impacting cardiovascular care
Research presented at Heart Failure 2023, a scientific congress of the European Society of Cardiology, outlined that women are more than twice as likely to die after a heart attack than men. (1) It was yet another reminder of the need to understand and account for gender differences in cardiovascular disease (CVD) pathology, prevention and treatment.
Factors influencing higher rates of CVD mortality among women include delayed diagnosis or incorrect initial diagnosis and less frequent administration of guideline- based treatments.
Hormonal influences may obscure risk factors, as premenopausal women often exhibit a degree of cardiovascular protection that diminishes after menopause, complicating the risk assessment. Diagnostic challenges arise because women present with subtler or atypical symptoms that are often overlooked or misinterpreted, leading to treatment disparities.
Genetic predispositions and lifestyle factors contribute to women’s risk profile, necessitating a gender-specific approach to prevention and management. Women are also underrepresented in cardiovascular clinical trials, creating significant research gaps that impede the development of personalised interventions. To combat these disparities, awareness campaigns and education initiatives are imperative to promote the recognition of heart disease in women among both healthcare providers and the public. These efforts are essential to ensure that women receive timely and appropriate care to improve their cardiovascular outcomes.
The impact of menopause on women’s cardiovascular health
As women reach menopause, the natural decline in estrogen levels can lead to a range of cardiovascular concerns. Estrogen has been thought to play a protective role in blood vessel health, and its decreased presence during menopause is associated with adverse changes in the arterial wall, reducing its elasticity and contributing to an increased risk of atherosclerosis.
Moreover, changes in hormones during this transition can result in an unfavourable lipid profile, with rises in ‘bad’ cholesterol (LDL) and decreases in ‘good’ cholesterol (HDL), exacerbating cardiovascular risk. The accumulation of visceral fat, a type of body fat stored within the abdominal cavity, also becomes more pronounced during menopause. This is of particular concern, as increased visceral fat is linked to metabolic disturbances that can further threaten cardiovascular health.
In light of these factors, it becomes evident that menopause is a critical period for cardiovascular risk assessment in women. Healthcare providers must be vigilant in monitoring and managing these risks to mitigate the heightened vulnerability to heart disease posed by menopausal hormonal changes.
Accounting for sex and gender differences in CVD prevention and treatment
Recognising the significance of sex and gender differences in cardiovascular disease (CVD) prevention and treatment is paramount, as it can lead to more personalised and effective care for both women and men. Consideration of these differences is vital for numerous reasons:
Risk factors: Women may exhibit different risk factors for CVD, such as those related to hormonal influences, which can affect prevention strategies and treatment protocols.
Clinical guidelines: Current clinical guidelines may not fully reflect gender-specific needs. Incorporating sex and gender differences can lead to more accurate guidelines that ensure both women and men receive tailored care.
Treatment outcomes: Awareness and adjustment for gender disparities can improve treatment outcomes. Addressing referral biases and ensuring equal access to care can reduce the mortality and morbidity associated with CVD in women.
Tackling heart disease at the global level
Cardiovascular diseases are a major cause of death worldwide. In 2021, 20.5 million people died from a cardiovascular condition. Ischemic heart disease is currently the leading cause of premature death in 146 countries for men and 98 countries for women. (2)
According to the European Society of Cardiology (ESC), there are more than six million new cases of cardiovascular disease (CVD) in the EU alone and more than 11 million in Europe as a whole every year. CVD is the leading cause of death in men in all but 12 countries of Europe and is the leading cause of death in women in all but two countries.
Countries with the lowest mortality rates include Japan, France, and Korea, and it is suspected that lifestyle factors have a lot to do with this. However, with rapidly ageing populations, research on preventing and treating chronic diseases like heart disease and working collaboratively at the international level is vital. For example, in 2017, Japan’s Agency for Medical Research and Development (AMED) established an office in the UK to enhance collaboration with the UK and European countries in medical research and development. AMED and the MRC signed a Memorandum of Cooperation on February 1, 2017, agreeing to work together to accelerate medical R&D in areas such as infectious disease, antimicrobial resistance, regenerative medicine, and dementia.
A one-size-fits-all approach to cardiovascular care is inadequate. By integrating a gender-sensitive perspective into research, clinical practice, and education, healthcare providers can better understand and address the unique challenges that women face in the context of cardiovascular health.
References
2. https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023.pdf
