CVD in Women
Introduction
Cardiovascular disease (CVD) is the #1 killer of women both in Canada
and the US. Coronary artery disease is the main form of heart disease
that affects both women and men. One in 5 women have been told by their
physician that they have heart problems. More women than men die from
heart failure and stroke.
The risk factors that lead to the development of heart disease are increasing
and we can expect to see more heart disease develop in women over time.
These risk factors are the same as for the general population and include
obesity, inactivity, poor dietary habits, metabolic syndrome and elevated
cholesterol, diabetes, hypertension and smoking. Aggressive management
of risk factors can delay the development of heart disease, stroke and
congestive heart failure.
Prior to menopause women are relatively protected from the development
of heart disease. Hormonal protection delays heart disease by about tem
years on average. The presence of diabetes however overrides this protection.
When women do develop heart disease, particularly at a young age, it tends
to be more severe and have a worse prognosis. This is due both to delays
in diagnosis and the fact that at the time of diagnosis coronary artery
disease tends to be more diffuse or widespread in the coronary arteries
of women. Their coronary arteries are smaller and women tend to do poorer
with procedures such as angioplasty or bypass surgery.
Heart disease in women can be difficult to diagnose because the usual
presenting symptoms are less often present. A recent study of women presenting
with heart attack showed that the most frequent preceding symptoms experienced
more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance
(47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort,
a hallmark symptom in men. The most frequent acute symptoms were shortness
of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest
pain was absent in 43%.
These symptoms can be difficult to diagnose in women. Treadmill stress
testing, the usual test to diagnose coronary artery disease, can often
be falsely abnormal in women. More accurate tests such as stress nuclear
heart scanning or stress echocardiograms are necessary to exclude or diagnose
heart disease in women. These tests tend to be less readily available
and more costly and sometimes are inappropriately avoided, thus delaying
the diagnosis of what are often atypical or unusual presentations of coronary
artery disease.
Once coronary artery disease is diagnosed there continue to be problems
with inadequate therapy to control symptoms as well as risk .These problems
apply to all patients with heart disease and cardiac risk factors. Bridging
this Care Gap is the main focus and purpose of this website.
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