Women have unique risk factors for heart disease that need to be taken into account in prevention and treatment strategies, according to a Cleveland Clinic cardiologist who led a team tasked with updating recommendations on women and cardiovascular disease for the American College of Cardiology.
Traditionally, doctors have treated men and women as the same when it comes to heart disease, but the director of the Women’s Cardiovascular Center at Cleveland Clinic, Leslie Cho, M.D., says that it is time to start thinking differently.
She explains: “For years, we’ve thought about men and women as having the exact same risk factors, namely, high blood pressure, hyperlipidemia, smoking, diabetes and family history. However, while heart disease is the number-one killer and most prevalent disease in women, women actually have very low risk in terms of the traditional risk factors.
“However, some conditions specific to women, such as endometriosis, have been found to raise the risk of developing coronary artery disease – the leading cause of heart attacks – by 400% in women under age 40.”
In compiling the updated recommendations, Dr. Cho and her team reviewed diseases that are more prevalent in women; sex-related differences in traditional risk factors; and risk factors that only women experience, such as those related to pregnancy.
Risks unique to women
In terms of pregnancy-related conditions, they noted that high blood pressure during pregnancy, gestational diabetes, preterm birth and miscarriages all increase a woman’s risk of developing heart disease. Identification of pregnancy-related conditions is important, says Dr Cho, as it can help identify younger women, with low traditional-risk scores, to allow for earlier monitoring of cardiometabolic factors and management.
Hormonal conditions specific to women have also been associated with increased heart risk. One of these is premature menopause, defined as menopause before the age of 40.
Dr Cho explains: “Estrogen offers women some protection from heart disease until after menopause, when estrogen levels drop. This is why the average age of for a heart attack in women is later, at 70, as opposed to 66 in men.”
Another sex-specific risk factor is a hormonal condition called polycystic ovarian syndrome (POCS), found in one in 10 women. This is associated with cardiometabolic factors, which, in turn, are associated with increased heart disease risk. The cardiometabolic factors associated with POCS include abdominal obesity, abnormal glucose control and diabetes, elevated blood pressure, and abnormal amounts of fats – such as cholesterol – in the blood, known as dyslipidemia.
Differences in traditional risks
Regarding sex-related differences in the traditional risk-factor category, it has been found that hypertension and diabetes are strong risk factors in women. Another risk factor, high blood pressure, is more common in women over the age of 50 than in men.
Woman are also more likely than men to experience depression or mental health issues, such as anxiety and chronic emotional stress, that can have an impact on their heart health.
“We really should be treating not just the blood pressure number, or the cholesterol number, but rather treating the whole patient, including their mental health, to have a good cardiovascular outcome,” says Dr. Cho.
She adds that studies have also shown sex differences in response to treatments, and doctors need to take these into account.
Common prevention strategies
Despite the different sex-related risks, Dr. Cho points out that there are common areas where either sex can lower their risk for heart disease by making changes to their lifestyles. Among these she includes avoiding smoking, getting regular exercise – at least a 30-minute walk daily – and maintaining normal weight, blood pressure, blood lipid and blood sugar levels. She recommends a diet high in fruits, vegetables, whole grains and fish, and low in animal products, simple carbohydrates and processed foods.
