Women and heart disease: A silent epidemic

Cardiovascular disease (CVD) is the leading cause of death worldwide, claiming more lives than all cancers combined. For women, heart disease presents an even more serious risk, often remaining unrecognized and even underdiagnosed. Despite significant advances in healthcare, there is still a dangerous misconception that heart disease is primarily a ‘man’s issue’. In fact, heart disease is the leading cause of death among women, accounting for one-third of all female deaths worldwide.

As we celebrate World Heart Day, it’s important to highlight the unique challenges women face when it comes to heart disease — both prevention and treatment. This article aims to raise awareness of gender disparities in cardiovascular care and advocate for more proactive heart health management in women.

The gender gap in cardiovascular disease

For many years, research and treatment protocols for heart disease were male-centric. The traditional symptoms of a heart attack, such as chest pain and shortness of breath, are more often associated with men.

Women, however, often experience more subtle symptoms such as nausea, dizziness, fatigue, and neck or jaw discomfort. These atypical presentations often lead to delayed diagnosis, undertreatment, and higher mortality rates in women.

Why are women at greater risk?

Biological differences: Women’s hearts and arteries are smaller, which may contribute to a higher incidence of microvascular disease, a condition where small vessels narrow or malfunction, leading to reduced blood flow.

Hormonal factors, particularly the decline in estrogen after menopause, also increase the risk of cardiovascular disease in women.

Unique risk factors: Women face certain risk factors for heart disease that are less common in men.

• Conditions related to pregnancy: Pre-eclampsia, gestational diabetes and hypertension during pregnancy are all important risk factors for developing heart disease later in life.
• Autoimmune diseases: Conditions such as lupus and rheumatoid arthritis, which are more common in women, increase the risk of cardiovascular disease.
• Emotional stress and depression: Women are more prone to stress and depression, which is one of the main causes of heart disease.
• Lack of awareness: Many women are unaware of their own risk of heart disease. A 2020 American Heart Association survey revealed that only 44% of women recognize heart disease as their leading cause of death.

Preventive strategies

The good news is that heart disease is largely preventable. However, women can be proactive in managing their heart health by focusing on lifestyle changes and understanding their unique risk factors.

Regular check: Women should prioritize regular health checks, including monitoring blood pressure, cholesterol and blood sugar, especially after the age of 40 or after pregnancy-related complications.

Adopt a heart-healthy lifestyle

Balanced diet: A diet rich in fruits, vegetables, whole grains and lean proteins can significantly reduce the risk of heart disease. The Mediterranean diet, in particular, has been shown to improve heart health in women.

Exercise: The American Heart Association recommends at least 150 minutes of moderate aerobic activity per week, such as brisk walking, swimming or cycling, to maintain cardiovascular health.

Quit smoking and limit alcohol: Both smoking and excessive alcohol consumption are significant risk factors for heart disease in women. Quitting smoking is one of the most important steps in reducing your risk of cardiovascular disease.

Mental health management: Given the strong link between stress, depression, and heart disease, managing mental health is critical to women’s cardiovascular health. Practices such as mindfulness, yoga, and counseling can reduce stress and improve overall well-being in women.

Risks for women in low- and middle-income countries

Women in LMICs face even greater challenges in managing heart disease. Limited access to health care, socioeconomic factors, and cultural norms often prevent women from seeking timely medical care. In addition, the burden of non-communicable diseases, such as diabetes and hypertension, is increasing rapidly in these regions, particularly among women.

Efforts must be made to address these barriers by improving health care infrastructure, increasing public health education, and promoting gender-specific cardiovascular research in LMICs. Community interventions and mobile health technologies can play a critical role in empowering women to take charge of their own heart health.

Heart disease is not just a man’s problem. Women need to be vigilant about recognizing their unique risk factors and symptoms, and they need to support their heart health. As health care providers, it is our duty to ensure that cardiovascular care is fair and inclusive.

This World Heart Day, let’s work together to close the gender gap in heart disease by ensuring all women have the tools and resources they need to live long, heart-healthy lives.

The author is a consultant in cardiothoracic surgery at the Aga Khan University Hospital. She to get to [email protected]