Female gender and cardiovascular disease

Abstract

Traditionally, cardiovascular disease has been mostly considered to affect men and discussions of risk, symptoms and threats focus primarily on men. The female gender is often overlooked and is not well studied in many aspects of cardiovascular research. In fact, only 30% of cardiovascular clinical trials since 2006 enrolled women, and only 50% of these trials actually involved gender analysis (Prata et al, 2014). Thus results obtained from clinical trials involving mostly men are extrapolated to women, ignoring the possibility of there being any gender differences. Far from being a problem restricted to men, cardiovascular disease is the leading killer in women. Globally, it is the greatest cause of death in women, accounting for one-third of all deaths and amounting to 8.6 million women each year. Myocardial infarction kills approximately four times as many women as breast cancer (Mozaffarian et al, 2015). Furthermore, cardiovascular disease kills a higher percentage of women than men: in 2004, cardiovascular disease was the cause of 32% of deaths in women as opposed to 27% in men worldwide (Vaccarino et al, 2010). While the mortality rate from coronary artery disease is declining in men, the opposite has been noted in women. The National Health and Nutrition Examination Surveys (NHANES) have found that the rate of myocardial infarction in middle-aged women (35–54 years) has increased over the past 20 years, while it has decreased over that time in men of the same age group. Cardiovascular disease develops 7–10 years later in women than in men; nonetheless, women have higher mortality rates. Over the age of 45 years, 26% of women die compared to 19% of men (Mozaffarian et al, 2015). Women also have a higher incidence of development of heart failure following myocardial infarction (46% in women vs 22% in men). Nonetheless, the great threat which cardiac disease poses to women is still greatly underappreciated, as evidenced in surveys among American women where about 50% of women were aware that heart disease is the major killer of women, yet only 13% acknowledged that it was their greatest personal health risk. This review unravels the underlying differences in symptomatology between male and female sex as well as analysing available data with regard to the best available options for diagnosis and treatment of cardiovascular disease in women.