Coronary heart disease, including heart attacks, is the leading cause of death in women and the second in men. This fact remains largely unknown to the general public, including many women themselves. This unfavourable prognosis is even more evident in women under 55 years of age, as various studies have shown.
Differences in the presentation of heart disease
Key differences in coronary heart disease between men and women include symptoms, risk factors and the type of coronary heart disease itself. The main differences are:
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Symptoms. Chest pain is the most common symptom in both women and men. In women, this is more frequently accompanied by a feeling of shortness of breath, unusual tiredness, nausea, vomiting and dizziness.
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Risk factors. High blood pressure, cholesterol, diabetes and smoking are all well-known risk factors for cardiovascular disease. Women with diabetes have a higher risk of suffering coronary heart disease than men. Also, smoking is increasing in women, especially younger women, and this has a negative impact on the risk of developing cardiovascular problems.
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Social and biological differences. Certain situations or moods, such as stress and depression, affect women more than men and can contribute to a worse prognosis for heart attacks in women. Autoimmune diseases are also more common in the female sex and are associated with a higher risk of cardiovascular disease due to their inflammatory nature. Additionally, certain stages in women's lives, such as menopause and the metabolic complications of pregnancy (e.g. gestational diabetes or hypertension) can increase the risk of cardiovascular problems. Socioeconomic factors, such as limited access to healthcare due to financial constraints, also play a significant role in disease outcomes
Types of heart disease in women
Compared to men, women have less obstructive coronary disease (fewer cholesterol-atheromatous plaques that cause significant narrowing of the arteries).
Among these non-obstructive causes, the most frequently occurring in women are:
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Spontaneous coronary artery dissection. A frequent cause of heart attacks in young women, often related to hormonal factors (may occur in relation to pregnancy) or systemic inflammatory diseases.
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Myocardial Infarction with Non-Obstructive Coronary Arteries. This is a condition sometimes related to situations of acute stress (such as Takotsubo syndrome) which mimics a myocardial infarction.
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Microvascular dysfunction or vasospasm. This is found in half of angina cases without significant coronary blockages.
These different types of coronary disease require specific diagnostic techniques, so the diagnosis should be exhaustive for adequate treatment to be given.
Personalised treatment
In documented cases of coronary obstruction, the artery involved can be opened using percutaneous revascularisation techniques, (intracoronary stent implants via circulation) or surgically (coronary by-pass). The technique chosen for each patient depends on the severity and number of arteries affected, as well as other associated diseases.
At the same time, treatments aimed at preventing new coronary events are prescribed, to prevent thrombosis, improve circulation and recover heart muscle contractility after a heart attack.
Preventing heart problems
It is essential to follow lifestyle habits that include a healthy diet and regular physical exercise, adapted to the circumstances of each person. Smoking and other harmful habits should also be avoided, while risk factors such as diabetes, high blood pressure and stress should be well managed.
There are specialised programmes for women at risk of cardiovascular problems, such as in high-risk pregnancies or when undergoing cancer treatment. These programmes promote preventive measures throughout a woman's life and can make a significant contribution to improving cardiovascular health.
Future prospects: reducing sex bias
Raising public awareness about the high risk of cardiovascular disease is essential, especially among women themselves. Educational initiatives, campaigns, health habit promotion and specific research that take into account sex-specific factors (e.g. hormonal and genetic influences) can contribute to a greater understanding of the disease; leading to improved prevention, early diagnosis and treatment tailored for women.
