Cardiovascular Disease - An Equal-Opportunity Killer

by Women's Brain Health Initiative:Cardiovascular Disease is a Serious Problem for Women.Cardiovascular disease—which includes heart disease and stroke—is often thought of as a problem primarily impacting men. But according to an American Heart Association (AHA) 2016 Scientific Statement, it’s actually an “equal-opportunity killer.” The researchers noted that cardiovascular disease is the leading cause of death among American women and that the number of women dying as a result of cardiovascular disease each year has been higher for women than men since 1984.The situation is a bit different in Canada. Statistics Canada data for 2011 indicates that cardiovascular disease is the second-most common cause of death for both women and men, after cancer. And, almost equal numbers of women and men died from cardiovascular disease that year—30,437 and 30,473 respectively. Clearly, cardiovascular disease is not exclusively a man’s disease.Cardiovascular Disease is Different for WomenBoth women and men have cardiovascular disease in large numbers, but their experiences with the disease vary significantly. For starters, women tend to have worse outcomes than men. The 2016 AHA Statement points out that more women than men die within a year of a first heart attack (26% versus 19%), and those percentages get worse with time; within five years of having a first heart attack, 47% of women will die compared to 36% of men.Women’s symptoms are often different as well. Although most people having a heart attack will experience intense chest pain, women often have more subtle chest pain they might describe as pressure or tightness, and they are more likely than men to have symptoms unrelated to chest pain such as: pain or discomfort in one or both arms, the neck, back, jaw or stomach; shortness of breath; unusual fatigue; and/or nausea, vomiting or lightheadedness.These differences in symptoms can impact the timely identification of heart disease in women, first by the women themselves and later by the health professionals. When symptoms are subtle, they are easier to miss or ignore. Women can incorrectly assume their symptoms are the result of non-life-threatening conditions such as acid reflux, the flu or normal aging.As a result, women tend to wait longer than men do before seeking medical help. One study found the median time women waited before seeking care when experiencing heart attack symptoms was 53.7 hours, compared to just 15.6 hours for men.Then, once women have arrived at the hospital seeking help, it can take them longer to be diagnosed than men, or their condition may be missed entirely and they are sent home being told they are fine.One of the reasons why some women are told they are fine when they are not is that they have a condition that is difficult to detect - coronary microvascular dysfunction. When someone has this condition, plaque accumulates evenly in the very small arteries of the heart, narrowing the arteries so that blood flow is restricted, but not completely blocked. This type of dysfunction reduces oxygen flow to the heart, and can cause pain similar to that experienced by individuals with blocked arteries, but it is not detected by standard diagnostic procedures such as angiograms. As a result, this condition often goes undiagnosed and untreated.Coronary microvascular dysfunction occurs frequently in women, and is far more common in women than men. Pepine et al. reported in the Journal of The American College of Cardiology in 2015 that approximately 60% to 70% of women undergoing coronary angiography to further evaluate suspected heart disease were found to have non-obstructive coronary artery disease (another term for coronary microvascular dysfunction). Yet only 30% of men had similar results from their angiograms. A Canadian study found the difference between women and men was even greater, reporting that women with heart attack symptoms undergoing angiography were three times more likely to be found “angiographically normal” than men.It’s estimated that between 2 and 3 million women in the U.S. have coronary microvascular disease. There are currently no reliable estimates of prevalence among Canadian women, according to a 2012 academic review article by Arthur et al. from Hamilton and Toronto, Ontario—Women, Cardiac Syndrome X, and Microvascular Heart Disease published in the Canadian Journal of Cardiology. However, the Canadian researchers estimate the incidence rate (i.e., number of new cases each year) is likely between 1,586 and 4,756 women in Ontario alone. The researchers emphasize the significance of these numbers, pointing out that if their Ontario estimate were extrapolated for the entire country, “the potential number of patients with this complex and costly problem (in both human and financial terms) is of significant importance to cardiac care.”Dr. C. Noel Bairey Merz, a leading researcher on women’s heart health and Director of Cedars-Sinai Barbra Streisand Women’s Heart Center in Los Angeles, explained, “When a diagnosis of coronary microvascular dysfunction is missed and women do not receive treatment, they remain at risk for having a heart attack. Many of these women whose angiograms indicate they have no blockages will continue to experience symptoms, a declining quality of life, and repeated hospitalizations and tests.”She continued, “That is why it’s so important to continue studying women’s uniqueness when it comes to cardiovascular disease, and to develop better tools for diagnosing and treating heart disease in women.”Steps Women Can Take to Prevent Cardiovascular DiseaseWomen and men are both affected by many of the same risk factors for cardiovascular disease, including: hypertension, waist-to-hip ratio, diet, physical activity, alcohol consumption and cholesterol levels. However, some risk factors affect women’s risk more strongly than men’s: tobacco abuse, type 2 diabetes and psychosocial factors, e.g., depression and stress. The good news is that all of these risk factors are considered “potentially modifiable,” meaning one can make healthy lifestyle choices and/or seek medical treatment to potentially eliminate these risk factors or decrease their impact.Research shows that the majority of women need to take proactive steps to prevent cardiovascular disease. It’s estimated that only about 20% of U.S. young and middle-aged women would currently be considered low-risk (because they have favorable levels of all five major traditional risk factors—smoking, hypertension, diabetes, serum cholesterol and body mass index). That means 80% have one or more of these risk factors!Good sleep habits may also help women keep their hearts healthy. In another article in this issue, we examine sleep and its effect on brain health. Sleep has the potential to also impact cardiovascular health, particularly for women. Researchers at Duke University Medical Center in Durham, North Carolina found that poor sleep is associated with greater psychological distress as well as higher levels of biomarkers associated with elevated risk of heart disease and type 2 diabetes; and, these links were significantly stronger in women than in men.“Poor sleep” was measured by the total amount of sleep, the degree of awakening throughout the night, and how long it took to get to sleep. The greatest risk for women was associated with length of time to fall asleep; women who took 30 minutes or longer to fall asleep had the worst risk profile. These results were reported in the August 2008 issue of Brain, Behavior, and Immunity.Source: MIND OVER MATTER - V5