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Women’s Health Month: Women are more susceptible to cardiovascular diseases than men. These are a group of disorders of the heart and blood vessels, and are usually associated with the build-up of plaque inside arteries, and an increased risk of blood clots. According to the World Health Organization (WHO), cardiovascular diseases include coronary heart disease, which is a disease of the blood vessels supplying the heart muscle; peripheral arterial disease, which is a disease of blood vessels supplying the arms and legs; cerebrovascular disease, which is a disease of the blood vessels supplying the brain; and heart attacks and strokes, among others.
Heart attacks and strokes are mainly caused by a blockage that prevents blood from flowing to the heart or brain, usually due to the build-up of plaque on the inner walls of the blood vessels that supply the heart or brain.
A stroke occurs when blood flow to the brain is blocked, preventing the supply of oxygen and nutrients to the organ. Sometimes, sudden bleeding in the brain can damage brain cells leading to a stroke.
Why women are more prone to cardiovascular diseases than men
The Centers for Disease Control and Prevention (CDC) states that coronary heart disease, also called coronary artery disease or ischemic heart disease, is the leading cause of death for women.
Coronary artery disease, which is the most common type of heart disease, is caused by the build-up of cholesterol and plaque on the inner walls of the arteries that supply blood to the heart muscle, causing them to become hardened and narrowed. The build-up of plaque is called atherosclerosis, which reduces the flow of blood through the arteries, resulting in an inadequate supply of blood or oxygen to the heart muscle.
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A reduced supply of blood or oxygen to the heart muscle can lead to a heart attack, or chest pain, which is called angina in medical terms.
When the flow of blood that brings oxygen to a part of the heart muscle is blocked, a person suffers from a heart attack.
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Increased susceptibility to coronary heart disease and heart attacks in women
Certain factors tend to put women at a higher risk of cardiovascular diseases such as coronary heart disease and heart attacks. These include reduced levels of oestrogen in women following menopause, because the protective effects conferred by the hormone to the heart decrease as women age, increasing their tendency to develop heart disease, according to Dr Ankita Chandna, Associate Director, Obstetrics and Gynaecology, Max Super Speciality Hospital, Shalimar Bagh.
She explained that societal and cultural factors such as disparities in healthcare access and treatment also contribute to increased vulnerability to cardiovascular diseases in women.
“In the United States, statistics from the American Heart Association (AHA) show that one woman every minute dies from heart disease and an estimated 44 million American women are affected by cardiovascular diseases. Common risk factors for heart disease among women include high blood pressure, high cholesterol, diabetes, smoking, sedentary lifestyle, obesity and family history of heart disease,” Dr Devendra Kumar Agarwal, Principal Consultant, Cardiac Sciences, Max Super Speciality Hospital, Shalimar Bagh, told ABP Live.
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He also said that coronary heart disease often presents differently in women compared to men. This is because women not only feel chest pain, but also experience other symptoms that are less associated with heart attacks. “These include dizziness, shortness of breath with or without chest pain, nausea, pain or discomfort in the back, jaw, stomach or both arms, cold sweats, and vomiting, among others. In women, these symptoms should not be ignored and one should seek medical attention promptly as delay can lead to permanent cardiac muscle damage or even can prove fatal.”
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According to Dr Mithee Bhanot, Senior Consultant, Obstetrics and Gynaecology, Apollo 24|7, and Apollo Hospitals, Sector-26, Noida, the uncommon symptoms that appear in women before a heart attack occurs may lead to delayed treatment, and hence, they have higher risk of mortality from heart attack than men.
People, especially those with hypertension, high-blood sugar and high cholesterol levels, must adopt healthy lifestyle practices.
“There are several ways to reduce the risk of heart disease. The WHO suggests cessation of tobacco use, reduction of salt in the diet, eating more fruits and vegetables, performing regular physical activity and avoiding harmful use of alcohol to reduce the risk of cardiovascular disease. Along with these measures, the people who have high blood pressure, high blood sugar and high cholesterol levels should control these levels through lifestyle and dietary modifications and medications as prescribed by healthcare professionals,” Dr Agarwal said.
Increased susceptibility to strokes in women
Stroke is the second leading cause of death worldwide, and is more common in women than in men. According to experts, one in five women gets a stroke in middle age, while the prevalence in men from the same age group is one in six.
“Not only is stroke more common in women, but also stroke outcomes are worse in females. There are several risk factors for stroke which are common for men and women. However, the impact of the same risk factors is higher in women,” Dr Rajiv Anand, Senior Director, Neurology, BLK Max Super Speciality Hospital, told ABP Live.
Study shows that risk of stroke in people with a systolic blood pressure in the range 120 to 129 mm Hg is similar to a systolic blood pressure in the range of 140 to 149 mm Hg in men, Dr Anand said. Also, prevalence of hypertension rises steeply in post-menopausal women, leading to increased risk of strokes.
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According to Dr Anand, diabetes, particularly for lacunar stroke, has a more unfavourable impact in women. When one of the arteries that provide blood to the brain’s deep structures is blocked, a lacunar stroke occurs, according to Harvard Medical School.
“Diabetes also confers a higher relative risk of dying from stroke in women. Other risk factors like atrial fibrillation, dyslipidemia, obesity and migraine with aura also contribute to stroke in women,” Dr Anand said.
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Atrial fibrillation is an irregular and very rapid heart rhythm, or arrhythmia, which begins in the upper chambers (atria) of the heart, and can lead to blood clots in the organ, according to Mayo Clinic.
The imbalance of lipids such as low-density lipoprotein, high-density lipoprotein, and triglycerides, leading to unhealthy levels of lipids in the blood, is known as dyslipidemia. This disease increases the chances of atherosclerosis.
Both atrial fibrillation and dyslipidemia are linked with increased risk of strokes.
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Gestational hypertension, which can occur during pregnancy, also increases the risk of stroke in women. Use of birth control pills and smoking can also make women more susceptible to strokes.
“Gestational hypertension and diabetes significantly enhance the risk of stroke in women. The usage of certain birth control pills in combination with smoking is also a risk factor for stroke in women. In addition, the risk of stroke increases with age. Increased blood pressure, lack of exercise, and not taking medicines on time are also risk factors for stroke. Since women usually live longer than men, more women have strokes in their lifetimes,” Dr Bhanot said.
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The use of postmenopausal oestrogen supplements also increases the risk of stroke-related mortality and morbidity in women, according to Dr Anand. He explained that in pregnancy, there is an increase in procoagulant activity in maternal blood. This means that there is an increase in the precursors of blood factors necessary for coagulation, which increase the risk of strokes.
Pregnancy is also associated with increased risk of inflammatory and autoimmune diseases which can lead to strokes. Haemorrhagic stroke, which is characterised by bleeding in the brain due to the rupture of a blood vessel, may occur due to pregnancy-induced hypertension.
“This gets further compounded by the fact that less women seek treatments for risk factors than men. Also, acute stroke treatment and post-stroke care are worse for women in our society,” Dr Anand said.
Therefore, experts conclude that women have a higher prevalence of strokes than men due to the severe impact of common and uncommon risk factors, and women-specific risk factors.
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