Heart disease is the leading cause of death in women, with coronary artery disease being the major cause of heart-related deaths. There are some factors unique to women that influence the occurrence of these diseases. Among them, premature menopause, early menarche, gestational diabetes and preeclampsia, polycystic ovarian disease with metabolic syndrome, premature ovarian insufficiency, and the use of oral contraceptives in those with other cardiac risk factors all increase the probability of a woman developing coronary artery disease.
Though usually the coronary artery disease has an onset later by 10 years than men, if these risk factors are present, they may occur early. Though hormones provide unique protection to women before menopause, currently there is no indication for giving hormone replacement exclusively to prevent cardiovascular diseases. Some diseases more common in women, like autoimmune diseases (SLE, Rheumatoid arthritis), can cause early onset of coronary artery disease. Treatment for breast cancer, which involves chemotherapy, can cause heart failure and coronary artery disease.
Women usually present with symptoms of heart attack like chest pain, breathlessness, giddiness, sweating, loss of consciousness, and palpitations. The problem lies in the delayed presentation of the patient to a medical facility, which is more common among young women. The delay in seeking medical care, neglect of symptoms, and unawareness make the condition more severe by the time they actually land up in a cardiac care facility. Even after they reach a medical facility, the process of care, getting to a catheterization lab, and undergoing treatment is delayed in women compared to men.
Amongst those women presenting with chest pain, those below menopause are considered low risk, those in their 50s and 60s as intermediate, and those in their 70s and above as high risk. Those with no limitations of activities of daily living in the intermediate risk category can do an exercise test, whereas those who cannot can be subjected to a stress echo, or CT calcium score or CT coronary angiography. Even after diagnosis, the initiation and follow-up of recommended therapies, be it medications or interventional procedures like angioplasty or coronary bypass, is less among women than men. These observations have come from studies done in the West; those disparities may be even worse in developing countries. Women also have a higher bleeding risk than men with the therapies given for heart disease.
Amongst the causes of heart failure, those related to pregnancy, the use of chemotherapy for breast cancer, and stress-related heart failure are common in women. Though the treatments remain the same in men and women, there are certain challenges when giving some drugs to pregnant and lactating women. With all these conditions, efforts must be made to prevent these, called primary prevention, modifying risk factors, and aggressive treatment of diabetes, hypertension, and high cholesterol levels. Once a person is diagnosed with a cardiac condition, efforts to give the best possible, guidelines-directed treatments and rehabilitation should be made.
(Author: Dr PRLN Prasad, Consultant - Interventional Cardiologist, Gleneagles BGS Hospital, Kengeri, Bengaluru)
