Authors : Lígia Mendes e José Ferreira Santos It is common to hear that women are less likely to have cardiovascular disease than men! But is it really true? Historically, cardiovascular disease and its manifestations, such heart attack or stroke , were actually more common in men. However, these differences have faded; It is now known that women have an equal or greater risk of having a cardiovascular event than men . Some facts about cardiovascular risk in women Cardiovascular disease is the leading cause of death in women! It kills more women than cancer! Up to 2 in 10 women develop hypertension, diabetes and pre-eclampsia during pregnancy, and these increase the risk of developing cardiovascular disease. After menopause, the risk of cardiovascular disease increases significantly. Often, women have atypical symptoms, which contribute to a late diagnosis of cardiovascular disease. Cardiovascular risk factors, such as high blood pressure and high cholesterol, are often undervalued by women and are not controlled, which increases their risk. Women have cardiovascular risk factors that men do not, for example hormonal changes, ovarian disease, pregnancy complications, among others. Cardiovascular diseases in women are still undervalued by many doctors, and this can delay diagnosis and effective treatment. What are the cardiovascular diseases that affect women? Women can be affected by the same cardiovascular diseases as men . The most important ones are: Heart attack and stroke, due to their frequency, risk of complications and mortality; But there is more, such as heart failure, hypertension, peripheral arterial disease, pulmonary embolism, arrhythmias, angina pectoris, among others. In women, diagnosis tends to be later, treatment is less effective, and the risk of complications tends to be higher. What are the symptoms that may be related to cardiovascular disease? In women, symptoms and clinical manifestations are often atypical and therefore are not always associated with the possibility of a cardiovascular event. Thus, intense symptoms, but not very suggestive of a heart attack, such as chest pain, but which interfere with normal activity, should be taken into account in women and justify the search for medical care. Back pain, shortness of breath, nausea, vomiting, fainting or just a general malaise are symptoms that can have multiple causes, among these cardiovascular diseases. Is pregnancy a cardiovascular risk factor? No! However, pregnancy and the peripartum are particularly vulnerable phases for a women cardiovascular health . Pregnancy is a physiological (normal) state that increases cardiac work and overloads the cardiovascular system. Between 5%-10% of pregnant women develop high blood pressure and in some more severe cases preeclampsia, a disease that can lead to serious heart complications and premature termination of pregnancy. The risk of gestational diabetes is also 5%-10%, and the diabetes may resolve after delivery or persist. Even in women whose diabetes resolves, the risk of recurrence persists throughout life. And diabetes doubles the risk of having a heart event. There are other cardiovascular complications of pregnancy, fortunately rarer: Peripartum cardiomyopathy which can lead to severe heart failure; Spontaneous dissection of the coronary arteries, which causes acute myocardial infarction; Pulmonary embolism. Do female oral contraceptives increase the risk of cardiovascular disease? Healthy women can safely use all methods of contraception. However, taking pill with estrogen in its composition is associated with a small increase in the risk of cardiovascular diseases, for example: Deep venous thrombosis; Heart attack; Stroke. When additional risk factors are present, be it health problems (eg high blood pressure) or behavioral risk factors (eg tobacco use) the risk associated with taking the pill with estrogen increases exponentially. Thus, when there are cardiovascular risk factors or established heart disease, other types of contraceptives, alternatives to the pill with estrogens, should be discussed with the attending physician. And after menopause? Does hormone replacement therapy increase cardiovascular risk? With menopause: There is a marked reduction in the production of female sex hormones, which have cardioprotective actions; Body composition changes, with an increase in visceral fat, and a consequent increase in inflammation and insulin resistance; LDL cholesterol (low density lipoproteins) increases by 10%-15% and HDL cholesterol (high density lipoproteins) decreases; There are mood swings, which contribute to a vicious circle of reduced physical activity, weight gain and sleep disturbances, contributing to the development of high blood pressure, diabetes and dyslipidemia, factors that increase the risk of developing a cardiovascular event. Hormone replacement therapy has been the subject of controversy and should be discussed on a case-by-case basis with the attending physician . This type of treatment does not protect against the development of cardiovascular disease, as was believed for many years. However, hormone replacement therapy is effective in controlling menopausal symptoms and should be considered in women younger than 60 years and in the first 10 years after menopause. The type of therapy should be adjusted according to cardiovascular risk factors or history of heart disease. Are there measures to prevent cardiovascular disease for women? In the same way that cardiovascular disease can be prevented in men, women can also reduce the risk of having an heart attack and stroke by more than 90%! Taking the initiative to control cardiovascular risk factors, both those that are evaluated in routine medical surveillance, and the related with behavior, which depend on each one, is what you should do: Controlling blood pressure; Controlling blood cholesterol; Controlling blood sugar (glycemia); Practice exercise; Have a healthy diet; Maintain a healthy body weight; Do not smoke. Sources The facts about women and heart disease . American Heart Association. Timoteo AT, Ribeira R, Calé R, Moura B, Almeira AG, Gavina C. Saúde cardiovascular da mulher . Rev Port Cardiol 2023 Wenger NK. Women and coronary heart disease: a century after Herrick: understudied, underdiagnosed, and undertreated . Circulation 2012;126:604-11. Meet the cardiology clinical team from 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.
