The World Health Organization has issued an alert on cardiovascular disease for the next 20 years.1 Despite what many people still think, this disease isn’t just a concern for men. Every day, it kills more than 200 women in France2 and 25,000 around the world.2 Many times, delays in diagnosis and treatment occur because women don’t think they are impacted by this disease, leading to insufficient screening.3, 4 But eight out of every 10 cardiovascular events can be avoided with targeted information, health education and screening.5 Overall, cardiovascular mortality is declining thanks to effective emergency medicine, rapid paramedic responses and skilled hospital staff. This means people aren’t as afraid of a heart attack or other cardiovascular event these days. We think healing can come without consequences with a simple angioplasty, a surgical procedure, a prescription and medications. However, the reality is quite different. While overall cardiovascular mortality has been going down for the past 20 years, this decrease is not the same for every age or gender. While it’s declining for men at any age, a worrisome increase has been observed in women under 55. At the same age, in-hospital mortality from acute coronary syndrome is higher for women than men. This difference exists in every age bracket, but the younger the woman, the larger the disparity. It’s also important to remember that many women who survive a cardiovascular event will live in poor health, disabled by heart failure, vascular dementia or the significant after-effects of a stroke. This will make them vulnerable to financial difficulties and other challenges.2 There are still major biases related to cardiovascular disease in women that lead to many lost opportunities. Insufficient screening for risk factors and often atypical symptoms cause diagnostic errors with detrimental delays in treatment.4, 6 Women are also impacted differently in their everyday lives. Now that women’s role has changed in society, they have complex lives that force them to juggle professional and household responsibilities, and many face difficult financial or emotional circumstances. All this exposes more young women to harmful lifestyles, which in turn contributes to early development of cardiovascular disease. The whirlwind of professional and family obligations they have to face every day makes it difficult to find time to take care of themselves. They have a tendency to ignore their symptoms and delay medical intervention by continually putting off lifesaving appointments, often waiting until it’s too late. Some of them pay a very high price, falling victim to cardiac arrest they never recover from, a massive heart attack with irreversible acute heart failure or a stroke that significantly impacts motor or cognitive skills. A string of factors that damage the heart and arteries will then start adding up over the years, creating a destructive combination that endangers younger and younger women.7 These factors include tobacco use, stress, instability, sedentary lifestyle, overwork, unbalanced diet, excess weight, obesity, diabetes. Hormonal risks also add up: inappropriate contraception, pregnancy at later ages, endometriosis, polycystic ovary syndrome, and menopause. In most cases, these risk factors can be avoided through health education and screening at different hormone stages.3, 4, 6 It’s critical to remember that at the same age, women have more risk factors than men and experience more harmful impacts on their arteries.4, 6 Some women are also exposed to a double penalty. After healing from breast cancer treatment that didn't include formal cardiovascular monitoring, they’re at risk of having a cardiac event. In fact, they’re more sensitive than men to the side effects of radiation therapy and chemotherapy.6 It’s important to offer them a comprehensive treatment plan that includes cardiac monitoring through a care pathway with cardiac and gynecological monitoring.6, 8 It’s critical to better understand what makes cardiovascular disease unique in women, adapt treatments to their physiology and pharmacodynamics, provide screening at three hormone stages (contraception, pregnancy, menopause), promote targeted research, and combine all available resources so that every woman has the same level of information and quality of treatment. We need to act before it’s too late. 3, 4, 6, 8 Bibliography
1WHO, May 2018. The top 10 causes of death
https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death 2Causes of mortality in France. Bulletin Epidémiologique Hebdomadaire, November 2019 https://www.santepubliquefrance.fr/docs/bulletin-epidemiologique-hebdomadaire-12-novembre-2019-n-29-30-surveillance-de-la-mortalite-par-cause-medicale-en-france-les-dernieres-evolutions 3Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update A Guideline From the American Heart Association. J Am Coll Cardiol. 2011;57(12):1404 23. 4Woodward M., Cardiovascular Disease and the Female Disadvantage, Int J Environ Res Public Health. 2019 Apr; 16(7):1165. 5WHO, May 2017. Cardiovascular diseases.
https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) 6Maas A.H.E.M. Manual of Gynecardiology. Female-specific cardiology. Editions Springer. 2017. 7Gabet A, Danchin N, Olié V., Myocardial infarction in women: trends of hospitalization and mortality rates, France, 2002-2013. Bull Epidemiol Hebd. 2016;(7-8):100-8. 8Brown HL, Warner JJ, Gianos E, Gulati M, Hill AJ, Hollier LM, Rosen SE, Rosser ML, Wenger NK; American Heart Association and the American College of Obstetricians and Gynecologists. Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration with Obstetricians and Gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation. 2018 Jun 12;137(24):e843-e852.