Cardiovascular Disease in Women

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An article written by Shiva R. Mishra, MPH, Hsin Chung, PhD, and Michael Waller, PhD published in JAMA Network discusses the association between reproductive life span and the incident of nonfatal cardiovascular disease (CVD) in women. CVD is a group of diseases involving the heart or blood vessels, which includes hypertension, coronary artery disease, heart attacks, heart failure, heart valve problems, and abnormal heart rhythms. Early menarche and early menopause are known risk factors for CVD in women. Researchers looked at 12 studies, analyzing a total of 307,855 women in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) to investigate the correlation between reproductive life span in addition to the age at menarche and menopause.

From the women surveyed, the mean age at menarche was 13, the mean reproductive life span was 37.2, and the mean age at menopause was 50.2. They found that women with very short (<30) reproductive life spans were at 1.71 times higher risk of incident CVD events than women with reproductive life spans of 36-38 years. Women who had had both short reproductive life spans (<33) and early menarche (age <11 years) had the highest risk of CVD compared with the median menarche age and reproductive life span length.

A study lead by Saraschandra Vallabhojosyula published in Circulation: Heart Failure looked at sex disparities in the management and outcomes acute myocardial infarction-cardiogenic shock (AMI-CS) in the young. A total of 90,648 AMI-CS admissions between the ages of 18 and 55, during 2000 to 2017 were reviewed; 26% of which were women. They found that in young AMI-CS admissions, women were treated less aggressively. Women received less frequent coronary angiography than men (73% versus 78.7%), less early coronary angiography (49.2% versus 54.1%) less percutaneous coronary intervention (59.2% versus 64%), and less mechanical circulatory support (50.3% versus 59.2%). Subsequently, female sex was an independent predictor of in-hospital mortality (23% in women versus 21.7% in men).

The presentation of CVD looks different in men and women; despite the impact of CVD on women, awareness and education remain low. Assistant Professor of Medicine at Johns Hopkins School of Medicine Lili Barouch, MD explains “Women are much more likely to have atypical heart attack symptoms. While the classical symptoms, such as chest pains, apply to both men and women, women are much more likely to get less common symptoms such as indigestion, shortness of breath, and back pain, sometimes even in the absence of obvious chest discomfort”

Hanna Gaggin, MD, MPH and Andrew Oseran, MD, MBA wrote an article for Harvard Health Publishing regarding the gender differences in cardiovascular disease. A recent study based on over two million patients found that women were less likely to be prescribed aspirin, statins, and certain blood pressure medications compared to men. These types of medications are commonly used to prevent CVD or its progression. A general lack of awareness of CVD in women may lead to doctors missing heart attacks in women or delaying their diagnosis.

Regardless of your sex, it is your doctor’s responsibility to provide adequate prevention, diagnosis, and treatment to protect your cardiovascular health. Abramson, Brown & Dugan is committed to advocating for people who have been negatively impacted by medical malpractice. If you or someone you know has been harmed due to medical error, contact us today.

Elie Maalouf
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