The risk of cardiovascular disease in women is seriously ignored! European Heart Journal article opinion
Recently, a review article published in the European Heart Journal stated that due to misunderstandings, doctors have insufficient understanding of gender differences in cardiovascular disease and insufficient research, resulting in women having a higher risk of cardiovascular disease than men.
Cardiovascular disease has always been the leading cause of morbidity and mortality in women. According to WHO statistics, ischemic heart disease, stroke and hypertension caused the deaths of more than 7.5 million women worldwide in 2019. Mortality rates are similar to men.
Coronary artery disease accounts for more than 50% of cardiovascular deaths in women, and more than one-third of women develop some degree of coronary artery disease by their 40s.
Women who develop acute coronary syndromes (including ST-segment and non-ST-segment elevation myocardial infarction) also have higher in-hospital mortality than men.
However, delays are more likely in female patients who develop coronary artery disease. Additionally, women are less likely to receive the same treatment than male patients.
Clinical trials evaluating the safety and efficacy of cardiovascular disease management have almost always been dominated by men. Two-thirds of clinical studies included male patients.
In 2018, an analysis of clinical trials for cardiovascular disease (including heart failure, coronary artery disease, and acute coronary syndrome) revealed that women were underrepresented in nearly all clinical trials. Additionally, women were more likely to be lost to follow-up during the trial.
What’s more, a recent survey in the UK showed that the public believes that cardiovascular disease, particularly stroke and ischemic heart disease, mainly affects men.
This misunderstanding can have serious consequences. For example, the most common symptom of acute coronary syndrome is chest pain, which is equally common in women and men. Women with acute ischemic symptoms usually seek medical treatment later than men. Delayed treatment will increase mortality.
Cardiovascular disease is associated with multiple risk factors, including smoking, hypertension, hypercholesterolemia, and obesity. This has been an important goal in preventing cardiovascular disease. These risk factors affect women differently than men.
Women metabolize cholesterol differently than men, promoting the progression of atherosclerotic cardiovascular disease.
Women are less likely to receive or maintain statin therapy. Smoking increases a woman’s risk of cardiovascular disease by 25%. Lower intake of fruits, vegetables, dairy products, and fresh meats in women is associated with worse cardiovascular outcomes.
In addition, women are subject to additional risk factors compared with men, such as hormones, menopause, age at menarche, pregnancy, and pregnancy-related diseases. Gestational hypertension and gestational diabetes both increase cardiovascular risk in women.
Because non-obstructive myocardial infarction or non-obstructive coronary ischemia is more common in women, female patients with acute coronary syndrome cannot receive timely coronary intervention.
Additionally, women were less likely than men to receive dual antiplatelet therapy, statins, and other secondary prevention medications after MI. Fewer women also received cardiac rehabilitation after an acute coronary event.
Nowadays, the misconception that women have a lower risk of cardiovascular disease can be dispelled by further raising health awareness. Try to achieve equality between men and women in clinical trials, and we should also consider conducting more clinical trials dominated by women.
Research should focus on ways to reduce the high incidence and mortality of cardiovascular disease in women.
A 2018 cohort study of 1,272 STEMI patients showed that gender differences in in-hospital adverse events, including death, were reversed after implementation of a simple, standardized four-step STEMI protocol. Facilitates direct access to the cath lab for all patients during their visit.
This study shows that simple and effective approaches like this are an effective strategy for reducing gender inequalities in cardiovascular disease in women.
Another study showed that among elderly patients with non-ST-segment elevation acute coronary syndrome who underwent surgery and were effectively managed according to guideline recommendations, there were no gender differences in long-term clinical outcomes.
