Preventing cardiovascular disease in women: it’s a big picture

A new report highlights the many links between this disease and other health conditions.

In mid-April the European Society of Cardiology published its latest information on the prevention of cardiovascular disease in women and made two things clear.

One is that cardiovascular disease is about our entire bodies. The other is that although cardiology has traditionally focused on men, we need prevention strategies tailored specifically to women.

A reminder that ‘cardiovascular’ disease includes but is broader than heart disease. Under this umbrella we also have stroke and other diseases that involve narrowing of the arteries.

Here are some of the many ways that cardiovascular disease occurs or shows up in women (warning: it’s a long list).

Traditional cardiovascular risk factors: high blood pressure, diabetes, and smoking

High blood pressure, which is a strong predictor of stroke and heart failure, is more common in women than men.

Diabetes is also a bigger risk in women than men. In women, having type 2 diabetes increases their risk of cardiovascular disease 4-fold. In men it’s 2.5-fold.

And smoking has a stronger impact on women’s risk compared with men (3.3-fold vs 1.9-fold). If a woman smokes as many cigarettes as a man, her risk is five times greater.

Pregnancy

Pregnancy can predispose women to possible cardiovascular risk, for example, through complications such as gestational diabetes or pre-eclampsia.

One in two women who have gestational diabetes go on to develop type 2 diabetes within 10 to 20 years, and pre-eclampsia involves high blood pressure that develops after 20 weeks of pregnancy or postpartum.

Thyroid

Thyroid conditions (e.g. hypo- and hyperthyroidism) are far more frequent in women, and these have a direct impact on cardiac health.

Hypothyroidism — an under-functioning thyroid — can slow the heart rate and make our arteries more rigid. This forces blood pressure to increase to move blood around the body.

On the other hand, too much thyroid hormone makes our heart beat faster and harder. People with hyperthyroidism can have palpitations and high blood pressure.

Low vitamin D

Vitamin D helps to reduce inflammation and improve the function of the inner lining of our arteries, so too little seems to go hand in hand with a higher risk of cardiovascular disease.

Obesity and eating disorders

Nearly one-third of women around the world are obese, and this is especially problematic if we carry the extra weight around our middles.

But also, eating disorders such as anorexia and bulimia, which are more common among women, increase cardiovascular disease. The lack of nutrients adversely affects the structure and function of the heart.

Autoimmune disease

These are far more common in women. Lupus and rheumatoid arthritis, for example, double a woman’s cardiovascular risk, both because of the conditions themselves, but also because of their treatment which can increase the risk of high blood pressure and diabetes.

Kidney disease

Chronic kidney disease is more common in women. It causes inflammation and stiffer arteries and can damage the heart. Kidney disease, diabetes, and high blood pressure are often interlinked.

Gut health

Inflammatory Bowel Disease (IBD) and celiac disease also show up more in women. They increase cardiovascular risk because they can trigger chronic inflammation, but they have other flow-on effects too. For example, IBD can lead to anemia, low vitamin D, and depression.

Lung conditions

Asthma is more frequent in women, and treatments for it can raise cardiovascular risk. Any woman who has a tight chest or difficulty breathing should make sure she doesn’t have a cardiovascular issue and not just dismiss it as asthma related.

Asthmatics are also at greater risk of sleep apnea, which is linked to higher blood pressure, stroke, and heart disease. Postmenopausal women are just as likely to develop sleep apnea as men, but it’s often overlooked in us.

Breast and ovarian cancer treatments

Radiation therapy and some chemotherapy drugs can damage the heart and blood vessels, increasing the risk of heart failure, high blood pressure, abnormal heart rhythms, and blood clots.

Anxiety and depression

These are twice as common in women and highly correlated with increased cardiovascular risk.

One reason for greater levels of anxiety and depression among women might be that women are more often caregivers and victims of domestic violence, and we know that women in both situations are less likely to seek out medical support or continue with medical treatment.

I did say it was a long list…

Migraines

Although these are more common in women, we’re often not referred to a neurologist or a cardiologist, even though migraines and headaches can be associated with high blood pressure, stroke, or aneurysms.

Dementia

Women are more likely than men to have various forms of dementia, and there’s a connection between cognitive impairment and cardiovascular disease. High blood pressure, inflammation, and diabetes can be common to both.

Eye health

Eyes rely on circulation, so if the blood vessels feeding the eye have been damaged, an ophthalmologist might be the first person to identify the early warning signs of cardiovascular disease.

In addition, we know that:

• Women are more prone to dry eye after menopause, and medications used to treat high blood pressure or cholesterol can lead to dry eyes.
• Stiffer arteries are linked with the development of age-related macular degeneration, which is the main cause of vision loss in older people. It disproportionally affects women because they live longer.
• Women outnumber men in glaucoma cases, and heart disease significantly increases the risk of glaucoma.

Bone health

A link has even been drawn between the risk of cardiovascular disease and the risk of hip fracture because physical activity, a healthy diet, not smoking, and sufficient vitamin D are needed to avoid both. A postmenopausal woman with a high risk of cardiovascular disease is also likely to have a high risk of hip fracture.

While this isn’t exhaustive, it gives an idea of how interrelated symptoms around the body can be. GPs need to monitor them to spot potential connections, but equally, we need to be aware of this and not ignore symptoms that could be pointing to more than we realise.

Given cardiovascular disease is responsible for one in three deaths among women the world over, it pays to be cautious.

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