Cardiovascular diseases are not the exclusive heritage of man. Stroke is the leading cause of female death in Spain. Despite this, there is a widespread idea that women have a lower risk of thrombosis. And this is partly so up to a certain age. However, once menopause is reached, the risks even out.
Pregnancy, menopause and cardiovascular risk
Women who develop diabetes during pregnancy have a 7-fold increased risk of becoming diabetic throughout their lives. Similarly, hypertension during pregnancy, called preeclampsia, makes the appearance of later arterial hypertension 7-8 times more frequent.
Therefore, during pregnancy, women with this type of disorder should subsequently undergo closer follow-up for early detection. In addition, we know that diabetes is particularly damaging at a cardiovascular level for women, as is the case with smoking.
Repeated abortions and a history of premature births suspected to occur due to placental insufficiency are also markers of increased cardiovascular risk. Probably because poor circulation at the level of the placenta is related to microcirculation problems at other levels, these women should be screened for certain prothrombotic factors, such as hyperhomocysteinemia or antiphospholipid syndrome.
Early menopause should be considered when counselling women about their cardiovascular risk, mainly before 40-45.
Early menopause increases cardiovascular risk by 50% and is sometimes surgically induced when hysterectomy and adnexectomy have to be performed due to certain diseases.
Most common diseases in women
There are more frequent diseases in women that increase their cardiovascular risk. Depression, anxiety and other mood disorders cause sustained stress, increasing vascular damage through different mechanisms. Without forgetting that much of this damage is due to a worse lifestyle: they perform less physical exercise, have a higher consumption of toxic substances and have a high rate of abandonment of the prescribed medication.
Another relevant pathology is breast cancer, which affects 1 in 8 women. As with other tumours, the risk of thrombosis increases. But, in addition, there is cardiovascular damage mediated by the treatments that are used, such as chemotherapy agents, that increase the risk of heart failure. Radiotherapy can also damage the heart, especially coronary lesions, with an effect that can take years to appear. This widespread tumour has promoted cardio-oncology units, which are services that involve an oncologist and a cardiologist to reduce the impact of cancer treatments on cardiovascular health.
Autoimmune diseases, such as lupus or rheumatoid arthritis are also more common. These processes produce a chronic proinflammatory state. They are diseases that cause an increase in the inflammatory response at the vascular level. This inflammation increases the risk of thrombotic events due to endothelial damage. Circulation is impaired when the endothelium, the layer that lines our blood vessels inside, does not work well because an inflammatory response alters it. This is because healthy endothelium promotes vasodilation, better blood circulation and prevents platelet aggregation and thrombosis.
Recently, migraine with aura, more frequent in women, has been considered a disease to assess cardiovascular risk. In fact, in the presence of these migraines, it is recommended to avoid oral contraceptives and drugs with a recognised thrombotic risk when they coexist with smoking or other conditions. This is so because the presence of migraine also translates into a worse functioning of the blood circulation at the cerebral level.
Unique psychosocial aspects of women
Apart from the biological aspects mentioned, there are other very influential factors in the psychosocial sphere. From the social point of view, the role of women as caregivers at the family level stands out, postponing their health care. This factor has a negative influence, increasing the delay in requesting health care. On average, women seek care much later when she has a heart attack, with adverse prognostic consequences.
This characteristic role of women worsens follow-up in consultations, as well as in cardiac rehabilitation programs. Cardiac rehabilitation has strong scientific evidence for improving the prognosis of heart failure after a heart attack or cardiac surgery. However, it is underused in women, and for this reason, having a higher dropout rate than in men.
On the other hand, it is also known that women receive fewer heart transplants on average, fewer ventricular assist devices and fewer devices, such as implantable defibrillators or synchronisers. The therapeutic approach is distorted by sex, although this also occurs in the diagnosis. For example, it has been seen that women with chest pain treated in the emergency department receive fewer invasive studies, such as catheterisation, on average than a man with the same characteristics.
Sex is a key modulating factor of cardiovascular diseases. Traditionally, men have a higher cardiovascular risk at an early age, but we must not forget that after menopause, this risk is equal.
But it is that women also have a series of risk factors of their own, which enhance the classic ones, and that must be taken into account when assessing their cardiovascular risk.
Nor should we forget that there are psychosocial factors that also influence the cardiovascular health of women. Some depend fundamentally on the role of women at the family level, but others derive from assistance aspects. In some and others, we have much to improve in health education.