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Traditionally perceived as a predominantly male problem, cardiovascular diseases (CVDs) are in fact the number one killer of women.¹ Cardiovascular diseases cause approximately 46% of older women’s deaths globally, with the additional 14% of deaths caused by cancers – most commonly lung, breast, colon and stomach cancers.

More than 400,000 American women die each year from CVDs, at a rate that is close to one death per minute. ^2,3 Adding to the poor prognosis is the finding that nearly two-thirds of women with fatal outcomes never experienced any warning symptoms.³ The situation with CVDs in younger women also warrants attention.  The mortality from coronary heart disease among women age 35 to 44 years showed an average annual increase of 1.3% between 1997 and 2002.⁴ The projected increase in coronary heart disease deaths in 2020, compared to 2006, is 9% for women age 35-44 and 15.9% for women age 45-54.⁵

A complicating factor in developing a tailored treatment approach for women lies in the fact that they have been largely underrepresented in clinical trials. In addition, approximately three-fourths of clinical trials conducted in CVD subjects do not report gender-specific results.⁶ Researchers are now making an effort to close this information gap by including female subjects and comparing CVD outcomes between the two genders.

A recent study examined the association between multiple cardiac risk factors and the presence of obstructive coronary artery disease in men and women.⁷ The study found that women with diabetes, hypertension, and smoking had significantly greater odds ratios for obstructive coronary artery disease than men with identical risk factors. The differences between genders were even more pronounced in patients with multiple risk factors. Women with four cardiac risk factors had almost double the risk for obstructive coronary artery disease compared with men.

Another relevant study reviewed 64 cohort studies published between January 1^st, 1966 and February 13^th, 2013 in Medline and focused on identifying any sex differences in the effect of diabetes on the risk of CVD. ⁸ The study reported that diabetes increases the risk of incident coronary heart disease in women by more than 40% compared with men with diabetes. The reason behind such a difference in diabetes-related risk of coronary heart diseases in men and women is poorly understood. Higher levels of CVD risk factors and relative undertreatment in women do not account for all of the excess risk observed. Elucidating the causes behind gender differences in risk factors would have important implications in management and treatment of CVD in women.

It is an unfortunate fact that the increasing body of knowledge available on heart disease, associated risk factors and prevention measures often goes underutilized. The American Heart Association is working on raising awareness through education and advocacy.² The FDA has joined in these efforts by identifying four important guidelines for women: eating a heart healthy diet, managing existing health conditions, learning the facts about aspirin, and recognizing the signs of a heart attack. NIH’s The Heart Truth program sponsored by the National Heart, Lung, and Blood Institute aims ‘’to raise awareness about heart disease and its risk factors among women and educate and motivate them to take action to prevent the disease and control its risk factors.’’

Through targeted research, education, and close communication between the healthcare providers and patients, CVD outcomes in women will likely improve. Heart disease rarely develops in the absence of the major risk factors, such as: elevated levels of blood cholesterol, high blood pressure, smoking, obesity, and diabetes. February is American Heart Month – a perfect time to re-evaluate your own risks for CVD and prompt the women in your life to be proactive about their health. It is time to speak loudly about the silent killer.

 References

1. Women’s health. WHO Fact sheet no. 334. September 2013. Geneva, World Health Organization, 2011.
2. Cardiovascular Disease: Women’s No. 1 Health Threat. Fact sheet. American Heart Association. 2013.
3. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics – 2013 update: a report from the American Heart Association. Circulation. 2013; 127:e6-e245.
4. Ford, Earl S. and Capewell, Simon. Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 through 2002: Concealed Leveling of Mortality Rates. J Am Coll Cardiol. 2007; 50(22):2128-32.
5. Huffman MD, Lloyd-Jones DM, Ning H, et al. Quantifying options for reducing coronary heart disease mortality by 2020. Circulation. 2013; 127:2477–84.
6. Blauwet LA, Hayes SN, McManus D, et. al. Low rate of sex-specific result reporting in cardiovascular trials. Mayo Clin Proc. 2007; 82:166-170.
7. Ko DT, Wijeysundera HC, Udell JA, et al. Traditional cardiovascular risk factors and the presence of obstructive coronary artery disease in men and women. Can J Cardiol. 2014; 30(7):820-6.
8. Peters SAE, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systemic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia. 2014; 57:1542-1551.

Jasenka Piljac Zegarac is a scientist and freelance writer. She holds a PhD in biology and a BS degree in biochemistry, and contributes on a regular basis to several health and science blogs. Her scientific publications have gathered more than 1100 citations. She may be contacted for assistance with a variety of science and medical writing projects.