Women Have Unique Risk Factors for Heart Disease

Women don’t just exhibit different symptoms and manifestations of heart disease than men, they also have different risk factors.
While traditional risk factors—like hypertension, high cholesterol, diabetes, obesity, and smoking—are still relevant to women, the physiological differences in women still require extensive study. For example, we know that conventional risk factors have different “weights” for men and women: while smoking is a statistically greater risk factor for cardiac disease in women than in men, hypertension is a greater risk factor for men than women. What we don’t know is how factors like hormone levels, fat distribution, and metabolism affect and predict women’s heart disease.
There are also risk factors unique to women that are only now being introduced into the general body of literature. Researchers recently uncovered a link between heart disease and perinatal and peripartum between heart disease and perinatal and peripartum complications like preeclampsia, eclampsia, intrauterine growth retardation, and gestational diabetes; women who experience these issues during pregnancy often have greater levels of systemic inflammation, which puts them at greater risk for coronary disease.5
Autoimmune diseases like rheumatoid arthritis are also being looked at as correlating factors for heart disease in women because of the link between inflammation and microvascular disease. In a 2017 article, the Cleveland HeartLab observed, “The process doesn’t stop at the joints. The inflammation can damage systems throughout the body, including the skin, eyes, lungs, and heart. Inflammation narrows the arteries, raising blood pressure and reducing blood flow to the heart, for instance. No wonder people with rheumatoid arthritis have a 50 percent higher risk of experiencing a heart attack, twice the rate of heart failure, and more peripheral vascular disease than those without the condition.”6 A review of studies published in the journal Nature Reviews Rheumatology offered another startling statistic: findings suggested that more than 50 percent of premature deaths in patients with rheumatoid arthritis resulted from cardiovascular conditions. As it happens, 75 to 78 percent of those with rheumatoid arthritis are women.7
At the time of this writing, the American Heart Association has updated its clinical practice guidelines to include some of this information. However, the differing risk factors and risk factor weights and the common presentation of symptoms for women have not been included. In fact, beyond the piece about pregnancy complications, very little about sex and gender differences has been addressed at all. This is highly problematic.
Without the proper tests to identify women-specific heart issues like microvascular dysfunction, doctors are left to tell their patients, “Your angiogram and cardiac catheterization are normal, so… maybe it’s your anxiety.”
In other words, women are once again hearing, “It’s all in your head.”

References:

  • “AHA Guidelines Recognize Preeclampsia as 5. “AHA Guidelines Recognize Preeclampsia as CVD Risk Factor,” Preeclampsia.org, last updated February 2014, https://www.preeclampsia.org/the-news/53-health-information/517-aha-guidelines-recognize-preeclampsia-as-cvd-risk-factor; Cheryl Bushnell, MD, MHS, FAHA et al., “Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association,” Stroke 45, no. 5 (2014): 1545–1588. doi: 10.1161/01.str.0000442009.06663.48
  • “The Cardiac Risks of Rheumatoid Arthritis,” Cleveland HeartLab. August 7, 2017, http://www.clevelandheartlab.com/blog/the-cardiac-risks-of-rheumatoid-arthritis.
  • Deborah P. M. Symmons and Sherine E. Gabriel, “Epidemiology of CVD in Rheumatic Disease, with a Focus on RA and SLE,” Nature Reviews Rheumatology 7 (2011): 399–408, https://www.nature.com/articles/nrrheum.2011.75

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