Women especially at young age are experiencing an unprecedented increase in heart attacks and strokes. We attempt In this article to make the reader aware of the reasons for this.
How are women different from men for developing heart attack?
Women tend to develop cardiac disease 7-10 years later compared to men that is attributed to the protective effect of estrogen hormone, which is present till menopause.
What are the traditional risk factors for developing heart disease?
Both men and women are prone to develop cardiac problems if they have one or multiple risk factors listed below. They are called traditional because they have been in practice for the past 6 decades.
| Non-modifiable risk factors | Modifiable risk factors |
| · Age
· Male gender · Family history of cardiac disease (< 60 years) |
· Smoking
· Diabetes · Hypertension · Hyperlipidemia · Obesity |
Despite the absence of many of these risk factors, women worldwide are increasingly dying due to cardiac ailments.
Do traditional risk factors confer a disparate risk for developing cardiac problems in women?
Women are sensitive than men for the development of heart diseases when they have associated traditional risk factors.
For example:
- Diabetes: Women with diabetes have a 7-fold increase in cardiac events compared to only 3-fold increase in diabetic men.
- Smoking and tobacco use has been shown to enhance the risk by an additional 25% in women compared to men for development of heart attacks. In fact tobacco use has been responsible for 50% of cardiac events in women and confers a 3-fold increased events. Normally women develop heart attacks 7-10 years later than men due to the protective benefits of estrogen hormone. This protective effect is lost with tobacco use and if they develop diabetes.
Unique risk factors for cardiac problems in female gender include:
- Pre-eclampsia (High BP during pregnancy associated with complications)
- Diabetes during pregnancy
- Polycystic Ovary syndrome
- Early menopause
- Autoimmune diseases
Early menopause and risk of heart attack:
About 10% of women experience menopause naturally before the age of 45 years. This is called early menopause. Because of lack of estrogen in post menopausal women, it predisposes to cardiac events.
Compared to women of similar age, those who attain natural or surgical menopause (removal of uterus – Hysterectomy) less than 45 years are at 50% higher risk of developing heart attack and 20% increased risk of death. Those women who attained surgical menopause tend to have higher cardiac events compared to natural menopause. So women should be dissuaded to undergo uterus removal surgery unless there is a clear evidence that the procedure is definitely required. Hormone replacement therapy has been tried to mitigate this risk but in vain. Current guidelines are against hormone replacement therapy for early menopause.
What can we do to prevent these cardiac events in women?
Targeting traditional risk factors – diabetes, hypertension, lipids, sedentary life styles, inappropriate food choices and obesity form the bedrock strategy for reducing the risk of developing heart attacks.
But for women further measures are needed to address the unique risk factors for women. The American College of Cardiology in its 2019 guidelines notified pre eclampsia, early menopause and autoimmune disease as “risk enhancers” for cardiac disease. They also added that physicians should have a low threshold to treat those patients with risk enhancers by life style measures and cholesterol lowering drugs to reduce the risk of developing heart attacks.
Finally women should realize that they are no longer at low risk for developing cardiac ailments and need to understand there are new risk factors that put them at “enhanced risk” for developing heart attacks.
