As in other European countries, in Portugal cardiovascular diseases are the main cause of death. Therapeutic advances and cardiovascular prevention have played their part, and the trend is decreasing, but there is still a long way to go, and women stand out. In Portugal, cardiovascular diseases were responsible for almost 43% of deaths in 1980 and for around 26% in 2021. In 2021, almost 56% of these deaths were women, mainly at older ages. Heart attack and stroke are the main cardiovascular diseases that cause death. The relationship between women and disease, recognition of specific risk factors and role of health professionals are areas in which improvements can be made that can greatly help. Relationship of women with disease Women underestimate their own risk, regardless of the risk factors or established cardiovascular disease they have. This may be due to a lack of information about the impact of these diseases on mortality. For example, a study carried out in the USA showed that less than half of women knew that cardiovascular diseases are the main cause of death for their gender. Their greater focus on typically female diseases may contribute to fewer complaints and, consequently, less discussion and information about cardiovascular risk with the health team who monitor them, thus not addressing issues of lifestyle modification or specific therapy. S ocial stigma regarding body weight is also one of the reasons cited as a barrier to discussing cardiovascular health. Women-specific cardiovascular risk factors In addition to classic cardiovascular risk factors, such as smoking, diabetes, and hypertension (whose impact on women appears to be greater than on men), there are risk factors exclusive to women, determined by their biology and natural hormonal pathway related gynecological, obstetric and endocrinological issues. There is a set of conditions in pregnancy that independently contribute to future cardiovascular risk and that have increasing importance with later motherhood, such as: Hypertension during pregnancy; Gestational diabetes; Preterm birth; Intrauterine growth restriction; Abortion. International societies therefore advocate that a cardiovascular assessment should be carried out 3 months after birth, so that the risk can be discussed, and necessary preventive measures implemented. In women with early menopause (< 40 years), both the incidence of classic risk factors and the occurrence of heart attacks and strokes increase. Contraception should always be carefully addressed, especially in women with known heart disease. Other non-classical risk factors such as those related to rheumatological diseases and psychosocial factors (anxiety, depression) have an impact on the higher cardiovascular risk in women. The role of healthcare professionals It is known that there is less diagnosis and proactive treatment of cardiovascular disease in women than in men. There are studies that demonstrate a tendency to attribute a lower risk category to women, compared to men with equivalent risk, thus underestimating their probability of cardiovascular diseases. This may be one of the reasons why women receive less cardiovascular therapy, whether preventive or after a heart attack. There is also a lower tendency to refer women for targeted diagnostic testing or invasive treatment. Women have also been underrepresented in clinical trials: In the last decade, the representation of women in cardiovascular clinical trials was around 38%, which interferes with the evaluation of results and the quality of conclusions that can be drawn regarding women. It is urgent to raise awareness Recognizing the importance of cardiovascular diseases in women and investing in their prevention must be a priority for everyone. Author: Rita Carvalheira dos Santos Source Estatísticas da Saúde 2022. Instituto Nacional de Estatística 2024. Timóteo AT, Ribeiras R, Calé R, et al. Saúde cardiovascular da mulher. Documento de Consenso da Sociedade Portuguesa de Cardiologia, Sociedade Portuguesa de Ginecologia, Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal, Sociedade Portuguesa de Contraceção e Associação Portuguesa de Medicina Geral e Familiar. Rev Port Cardiol 2023;42:100115. Cho L, Davis M, Elgendy I, et al. Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state of the art review . J Am Coll Cardiol 2020;75:2602-18. Leifheit-Limson EC, D'Onofrio G, Daneshvar M, et al. Sex differences in cardiac risk factors, perceived risk, and health care provider discussion of risk and risk modification among young patients with acute myocardial infarction: The VIRGO study . J Am Coll Cardiol 2015;66:1949-57. Meet the Cardiology clinical team of the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
