Women and heart disease: A silent epidemic

Cardiovascular disease (CVD) is the leading cause of death globally, claiming more lives than all cancers combined. For women, heart disease presents an even graver risk, often remaining unrecognised and even underdiagnosed. Despite of the significant advancements in healthcare, there remains a dangerous misconception that heart disease is primarily a “man’s issue.” In reality, heart disease is the leading cause of death among women, accounting for one-third of all female deaths worldwide.

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

The gender gap in cardiovascular disease

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

Women, however, often experience subtler symptoms like nausea, dizziness, fatigue, and discomfort in the neck or jaw. These atypical presentations frequently lead to delayed diagnosis, under-treatment, and higher mortality rates in women.

Why are women at higher risk?

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

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

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

• Pregnancy-related conditions: Preeclampsia, gestational diabetes, and hypertension during pregnancy are all significant risk factors for developing heart disease later in life.
• Autoimmune diseases: Conditions such as lupus and rheumatoid arthritis, which are more prevalent in women, increase the risk of CVD.
• Emotional stress and depression: Women are more prone to experiencing stress and depression, which is one of the leading causes of heart diseases.
• 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 recognise that heart disease is their leading cause of death.

Preventive strategies 

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

Regular screening: Women should prioritise regular health check-ups, including blood pressure, cholesterol, and blood sugar monitoring, 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 major risk factors for heart disease in women. Quitting smoking is one of the most important steps to reducing their risk for CVD.

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

Risks for women in low-, middle-income countries

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

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

Heart disease is not just a man’s problem. Women must be vigilant in recognizing their unique risk factors and symptoms and should advocate for their heart health. As healthcare providers, it is our duty to ensure that cardiovascular care is equitable and inclusive.

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

The writer is a consultant at the cardiothoracic surgery at the Aga Khan University Hospital. She be reached at [email protected]