Heart Disease: It’s Not Just for Men

Coronary artery disease is more likely to be overlooked in women than in men

(RxWiki News) Coronary artery disease is seen by many as a man's disease. This potentially fatal heart problem, though, strikes at least as many women as men.

With coronary artery disease (CAD), cholesterol and other materials build up in the arteries. This buildup, called arteriosclerosis, blocks blood flow to the heart. It can lead to a heart attack and contribute to heart failure and arrhythmia.

A new report underscores that CAD is overlooked in women, and that many women may not be getting the same preventive care as men.

"Exercise regularly to help ward off heart disease."

Kavita Sharma, MD, a specialist in cardiovascular medicine, and Martha Gulati, MD, director of Preventive Cardiology and Women’s Cardiovascular Health at The Ohio State University, in Columbus, coauthored this report titled Coronary Artery Disease in Women: A 2013 Update.

Based on pooled estimates and data from 31 countries, Dr. Sharma and Dr. Gulati observed that women are less likely than men of similar risk to be recommended lipid-lowering therapy, aspirin and lifestyle advice to treat CAD.

Yet, the authors wrote, more women than men die of CAD, and more women have died from CAD than of cancer (including breast cancer), chronic lower respiratory disease, Alzheimer's disease and accidents combined.

Worldwide, 8.6 million women die from cardiovascular diseases (which include CAD) each year, according to the World Health Organization. These diseases continue to be the number one cause of death in both genders worldwide. The number of deaths related to cardiovascular diseases is projected to increase to 23.3 million by 2030.

The researchers highlighted that microvascular coronary disease “disproportionately affects women.” This is heart disease that affects the tiny coronary (heart) arteries, leaving the walls of these arteries damaged or diseased.

"CAD's impact on women traditionally has been underappreciated due to higher rates at younger ages in men," wrote the authors.

Dr. Sharma and Dr. Gulati also noted that the common risk factors for CAD may affect women and men differently. They cited one study finding that obesity increased the risk of CAD by 64 percent in women but by only 46 percent in men, for example.

Lack of physical fitness is a crucial risk factor. The authors referred to the results of one study (the St. James Women Take Heart Project) showing that women unable to carry out basic fitness tests were three times more likely to develop CAD than fitter women.

Diabetes is another major risk factor for women and men. The authors cited one study finding that a woman with diabetes is three times more likely to develop CAD than a woman without diabetes.

If a woman has a first-degree relative that has had CAD, her risk increases more than it would for a man.

In addition, women are also more likely than men to suffer autoimmune diseases. Polycystic ovary syndrome, pre-eclampsia and gestational diabetes are all conditions that can ultimately make CAD more likely in women.

The report also found women who had a CAD-related heart attack when they were under the age of 50 were twice as likely to die as men in similar circumstances. Among those over 65, women were more likely to die within the first year after a heart attack.

Overall, 42 percent of women who have heart attacks die within one year, compared to about a quarter of men. Compared with men, women are also 20 percent more likely to suffer angina (chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood).

There is some positive news, according to Dr. Sharma and Dr. Gulati. From 1998 to 2008, the rate of death from CAD declined 30 percent in the United States (with similar falls in other developed countries). Still, rates are actually increasing in women aged 55 years and younger.

Another positive, the authors said, is that awareness has risen. In 1997, only about one-third of American women surveyed were aware that the leading cause of death in women is CAD. In 2009, that number was more than half.

Doctors may need to become more aware of the risks of CAD in women. In one survey performed in 2004, fewer than 1 in 5 physicians recognized that more women than men die each year from CAD.

When it comes to cardiac rehabilitation after heart attack, women may also be shortchanged.  The authors highlighted data finding that women were 55 percent less likely to participate in cardiac rehabilitation than men.

Dr. Gulati told the dailyRx News, “Ultimately women need to be aware that heart disease is their number-one killer. We treat women differently compared with men and that needs to change. So we have a long way to go but we are learning more and more every day.”

This study was published in July in Global Heart, the journal of the World Heart Federation (WHF).

For more information on the WHF’s “Make a Healthy Heart Your Goal Campaign,” see the web site listed in the resources below.

Review Date: 
July 28, 2013