For years we have internalized health messages that associated pressure and pain in the chest, radiating to the left arm, as unequivocal symptoms of a heart attack. Also that this pathology was a problem for men, especially of advanced ages or young people subjected to a lot of stress, but it was uncommon in women. Nothing is further from reality.
The data shows that cardiovascular diseases are the leading cause of death in women around the world, ahead of the dreaded breast cancer, and that they were responsible in 2021 for 26.4% of the total deaths of this group in Spain, according to data from the National Statistics Institute. In Europe, cardiovascular diseases claim the life of a woman every six minutes, eight in the case of Spain, and one every 60 seconds in the US. In addition, mortality after a myocardial infarction is 20% higher in women than in men, among whom an average death rate between 35 and 74 years of age is 46%, compared to 53% in women of the same age.
The lack of information and awareness about the risk of CVD in women, both among patients and, on many occasions, among the medical community has been one of the main causes that explain why cardiovascular diseases are underdiagnosed and undertreated. Also the peculiarities of its clinical manifestation, very different in both sexes; or the underrepresentation of women in clinical trials, point out from the European Society of Cardiology.
One of the main problems facing the fight against CVD in women is the limited information and dissemination that has been carried out on the symptoms associated with cardiac pathologies in this group. As it manifests itself in a more diffuse and less specific way than in men, it is commonly underestimated, both by patients, who go to the doctor later, and by healthcare personnel. These admit the difficulties in identifying them due to the non-specificity of the symptoms and the fact that medical literature has historically focused on the signs in men, and that they are often confused with stress and anxiety disorders.
In this sense, North American registries such as CRUSADE, alerted by the Spanish Heart Federation, determine that only 15% of women receive adequate treatment when CVD symptoms appear, compared to 56% of men; that 62% of men’s visits are referred to a cardiologist, compared to 30% in the case of women; and that only 13% of women were prescribed appropriate medication for the treatment of cardiovascular diseases, compared to 47% of men.
Added to all this is the fact that cardiovascular diseases usually appear 10 years later in women than in men, mainly due to the role of hormones. Starting with menopause, women’s estrogen levels decrease, which multiplies cardiovascular risk factors (mainly diabetes, hypercholesterolemia, hypertension and obesity), since “estrogenic activity preserves the endothelial function of the arteries and decreases the cholesterol also reduces the viscosity of the blood, minimizing the risk of thrombosis,” they point out at the Spanish Heart Foundation.
In recent years, awareness has advanced to better understand, diagnose earlier and more accurately treat cardiovascular diseases in women, although an evident gender gap still exists. Various initiatives, such as the American Heart Association’s “Go Red For Women”; the “Women for Heart”, from the European Spociety of Cardiology; the “Directas al Corazón” campaign, from the Cardio-Dreams foundation; or the heart attack prevention program in women, “Mujeres con Corazón”, of the MAPFRE Foundation, the Pro CNIC Foundation, the Spanish Heart Foundation and the Community of Madrid have contributed and continue working to reduce this gap, raise awareness and inform about CVD in women to facilitate early recognition of their symptoms and to promote healthy lifestyle habits that help prevent them.
