September 22, 2005
Women and Cardiovascular Disease: A Silent Epidemic
According to the American Heart Association cardiovascular disease (CVD) kills nearly a half-million women every year. That’s nearly one woman every minute. It has been the leading cause of death in American women since 1900, but has gone virtually unrecognized until recently. Of all cardiovascular deaths, roughly 80 percent are due to heart disease and 20 percent due to stroke.
Risk factors for CVD are well known, but are too often left untreated in female patients, according to Denise Barnard, M.D., Director of the new UCSD Women’s Cardiovascular Health Program and Assistant Director of the UCSD Heart Failure and Cardiac Transplantation Program.
”Women are typically unaware of their risk of heart disease and stroke,” says Barnard. “Women are much more aware of breast cancer and think of heart disease as ‘a man’s disease,’ but the facts show otherwise. The odds of dying from breast cancer are one in 32, while the odds of dying from cardiovascular disease are one in 2.5 for the average woman over 40 years of age.”
In addition, Barnard points out that while a woman may have the same classic chest discomfort symptoms as a man with heart disease, there are several common variations in symptoms that women experience such as shortness of breath, gastrointestinal symptoms, fatigue, anxiety, palpitations and sweating. She adds that women tend to wait longer than men to seek medical attention for chest pain symptoms. Any delay in diagnosis and therapy for a heart attack risks greater heart damage, heart failure and death, says Barnard, adding the same holds true for stroke symptoms.
Barnard says numerous studies have shown that CVD can be prevented with aggressive treatment of modifiable risk factors. Among those risk factors adding to the rising incidence of CVD in women are smoking, diabetes, high blood pressure, high cholesterol, obesity/overweight and lack of exercise. She notes that nearly 25 percent of American women report not engaging in regular physical activity. Considering approximately 52 percent of women over 45 have high blood pressure, and 40 percent of women over 55 have high cholesterol, Barnard says that the lifestyle of American women are putting them at high risk for cardiovascular problems and it is these very lifestyle choices that can be altered to prevent the onset of CVD.
Several risk factors appear to have a more significant impact on women than men. For example, she says, diabetes is a powerful risk factor in women, increasing CVD risk three to seven-fold compared with a two to three-fold increase of risk in men. This difference may be due to a particularly deleterious effect of diabetes on lipids and blood pressure in women. Hypertension also appears to hold a greater risk for women than men in the development of heart disease, heart failure, arrhythmia and stroke.
Barnard says a common misconception is that women are protected against CVD because they tend to have higher “good cholesterol” levels, HDL, than men do. However, the favorable influence of a high HDL is diminished or lost if the rest of the cholesterol profile (including the LDL, or “bad cholesterol”) is abnormally high. In addition, high triglyceride levels in women, especially older women, are a significant risk factor for cardiovascular disease. This does not appear to be the case for men.
To compound the problem, Barnard says medical practitioners are less aware and/or less aggressive about a woman’s CVD risk profile than they should be. She cites a recent survey by the Centers for Disease Control and Prevention Magazine’s National Ambulatory Medical Care Survey. The survey showed that clinicians are missing opportunities to prevent CVD in their female patients. In this study of 29,273 routine office visits, women were counseled less often than men about exercise, nutrition, and weight reduction. Further, says Barnard, hypertension and diabetes control rates fall far short of the goals of therapy recommended in disease management guidelines.
“We don’t do a good job of treating risk factors in women even after they have developed CVD,” says Barnard. “In the multicenter Heart and Estrogen/Progestin Replacement Study (HERS), only 10 percent of women enrolled who had previously documented heart disease had baseline LDL-cholesterol levels below 100 mg/dl, even though the latest goal for HDL is under 90 mg/dl. At the time of the study the LDL goal for persons with known CVD was <100, it’s now < 90. Ninety percent of the HERS participants who had known heart disease weren’t being treated adequately, to lower the risk of another cardiac event.”
In addition, Barnard says a national survey revealed that women were significantly less likely than men to enroll in cardiac rehabilitation after a heart attack or coronary bypass surgery. Patients not enrolled in cardiac rehabilitation are less likely to receive aggressive risk factor management.
Recommendations for aggressive CVD risk factor management are based on reducing the probability of a future cardiovascular event. Since first heart attacks and strokes are more often fatal in women, individualized risk factor management before the onset of symptoms is an especially critical prevention strategy, Barnard cautions.
Intermediate or high-risk women who have not yet developed symptomatic CVD should receive intensive treatment, she advises. This strategy recognizes that CVD is a slowly progressive disease process. Barnard advocates educational and outreach efforts to increase women’s’ awareness of risk, and she encourages primary care providers to be aggressive in identifying risk factors and achieving targets of risk reduction to slow the rising incidence of heart disease in both women and men.
Quick Facts: Women and Cardiovascular Disease
- Cardiovascular disease (CVD) is the leading cause of death among American women.
- One in five women over 45 years of age has CVD. Over the age of 65, it is one in three.
- Even in the age group 25-44 years, CVD is the second leading cause of death among women (behind accidental death).
- Since 1984, the total number of heart attack and stroke deaths for females has exceeded those for males every year.
- In 64% of women who died suddenly due to heart disease, there were no previous symptoms of the disease (that were recognized or diagnosed).
- After surviving a heart attack, 38% of women will still die within a year, compared to 25% of men.
- Within 6 years after a recognized heart attack,
--35% of women will have another one, compared with 18% of men.
--46% of women will develop heart failure, compared with 22% of men.
--11% of women will have a stroke, compared with 8% of men.
- The direct and indirect healthcare costs due to treat CVD in 2004 are estimated to be over 384 billion dollars.
Visit the UCSD Women's Cardiovascular Health Program website for more information and to assess your risk for heart disease.
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