Women and coronary heart disease (CHD)

CHD in women

• compared with men, women with CHD tend to be older, experience more symptoms, require more hospitalisations, and have lower ratings of general well-being. Younger, pre-menopausal women who present with myocardial infarction carry excess mortality when compared with men of a similar age
• as in men, most CHD in women is due to atherosclerosis, however there is some evidence that the mechanism of myocardial infarction may differ in some women from men
  • thrombosis caused by a ruptured atherosclerotic plaque is the commonest cause of infarction in men, whereas in women endothelial erosion leading to thrombosis is commonly found without plaque rupture
• important risk factors for CHD
  • identifying and managing the traditional risk factors for primary and secondary prevention of CHD in both men and women is vital. Most of the risk factors have a similar influence on cardiovascular risk across the sexes. Some specific considerations in women are:
    • age - is an important risk factor in both men and women, but women are on average 10 years older when they develop CHD which is probably related to post menopausal hormonal change
    • hypertension - more women than men develop hypertension as they get older. Isolated systolic hypertension is more common than in men
    • metabolic syndrome - this is more prevalent in women than in men with coronary heart disease
    • psychosocial factors such as depression associate more strongly with increased risk of CHD in women than in men

Calculating CVD risk in women

• use of risk algorithms such as the Framingham risk score have been shown generally to underestimate the individual risk of CHD in women. Alternative gender-specific risk scoring systems are available, such as the SCORE (ESC) and QRISK (UK)

Notes:

• a previous factfile noted also (2)
  • ethnic differences - Asian women seem almost twice as susceptible to CHD than other women in the UK
  • physical inactivity - levels of physical activity in girls show a sharp decline after the age of 8 or 9 years, and fewer women in the UK take regular physical activity. Only about 20% undertake activities such as swimming, dancing and cycling and 2/3 are so unfit that they cannot walk at a normal pace up a gradual slope with becoming breathless (1)..encouraging regular walking, initially 20 minutes, 3 times per week up to half an hour or more for at least five days a week, can have major benefits in terms of reducing risk of developing type 2 diabetes, improving blood pressure and cholesterol levels and reducing overall risks of CHD

Reference:

• 1) BHF Factfile (November 2010). Women and coronary heart disease.
• 2) BHF Factfile (February 2003).Coronary Heart Disease in Women.