Women and heart disease

Cardiovascular disease (CVD) is still widely considered as a middle-aged man’s disease and this is clearly a misconception. In actual fact, CVD is the number one cause of death for women worldwide. Also, compared with men, women have a number of additional risk factors that are specific to them and should not be ignored by medical professionals. Laboratory testing has a key role to play in the diagnosis and follow up of women with CVD. CLI talked to Jean Onofrio, Senior Director, Global Assay Marketing, Siemens Healthcare Diagnostics, about this important health issue for women.

Q.What impact does cardiovascular disease have on women?
Cardiovascular disease, or CVD, is a significant health concern for women. In fact, it’s the number one killer of women globally, [1] and according to the World Health Organization (WHO), accounts for one-third of deaths in women. 

CVD also is the main cause of death for older women. Women generally develop CVD about 10 years later in life than men, likely due to the protective, anti-oxidant effects of estrogen prior to menopause.

Unfortunately, the misperception that CVD is a middle-aged man’s disease still persists. Understanding CVD’s global impact on women is one positive step toward battling the disease.

Q. What are the risk factors for CVD in women?  How do these compare to risk factors in men?
While many CVD risk factors, such as age, family history and high blood pressure, are similar in both genders, there are some, including diabetes, tobacco use and high triglyceride levels, that put women at higher risk. Other risk factors, like obesity and depression, are more prevalent in women. There are also some risk factors unique to women, including pregnancy complications, oral contraceptive use, hormone replacement therapy and polycystic ovary syndrome. It’s important for women to understand their CVD risk factors and discuss their concerns with their physician.

Q. How does the mortality rate of women with CVD compare to the mortality rate of CVD in men?
While the mortality rate is high for older women, a heart attack can occur at any age. For younger women, heart attacks are actually more deadly than for men.  According to the American Heart Association (AHA), among adults aged 45-62, women are twice as likely as men to die within the first year after a heart attack.

Also, more than twice as many women will develop heart failure within five years of surviving a heart attack compared to men, and three times more women than men will suffer a stroke after surviving a heart attack.

Q. What are some of the challenges associated with diagnosing CVD in women?
Women having a heart attack commonly present with symptoms other than chest pain, which makes diagnosis challenging. Rather, women often experience such less common symptoms as fatigue, indigestion, appetite loss and
“heart flutters.” 

Even though these symptoms may not be severe, they may still lead to deadly consequences. Unfortunately, many women, and often clinicians, disregard their symptoms, attributing them to other non-life-threatening conditions.

Adding to this challenge, women with CVD aren’t as likely as men to receive aggressive diagnosis and treatment. Consider that women receive only about 34 percent of interventional treatments, with and witout the placements of stents.

Q. What role does laboratory testing play in the diagnosis and management of women with CVD?  What about biomarkers?
CVD is largely preventable, and simple laboratory tests can help assess a person’s risk.

Laboratory professionals play an increasingly important role in providing access to both traditional and novel cardiac biomarkers that are available throughout the disease continuum. Also, whether conducted in the central lab or at the point-of-care, cardiac tests, such as high-sensitivity troponin, are key diagnosis tools.

By leveraging the appropriate use of laboratory diagnostic testing, clinicians can help enhance the assessment, diagnosis and follow-up care for women with CVD.

Reference
1.http://gamapserver.who.int/gho/interactive_charts/women_and_health/causes_death/ chart.html; accessed 11/27/12