Cardiovascular disease (CVD) is one of the leading causes of ill health worldwide. Although data show that CVD is less prevalent in females than males, CVD may be underestimated in the female population. Female patients often receive suboptimal treatment and suffer greater mortality from CVD than men. Women are twice as likely as men to die of coronary heart disease.
Learn more about this topic in the HealthCert Professional Diploma program in Women's Health: fully CPD accredited online women's health training for GPs, quality-assured by Bond University.
Early detection of CVD in all patients is beneficial to the overall prognosis, and primary care practitioners should maintain a high level of suspicion in any female patient with risk factors or symptoms of CVD.
CVD risk factors include hypertension, diabetes, hypercholesterolaemia, smoking, poor diet, obesity, and physical inactivity. There are also gender-specific risk factors in the female population, such as menopause, gestational diabetes, hypertensive disorders of pregnancy, use of oral contraceptives and hormone replacement therapy (HRT), which are often overlooked.
While early CVD is asymptomatic in both sexes, CVD symptoms include chest pain on exertion and shortness of breath. Female patients may present with more subtle signs, such as fatigue or nausea, which may be attributed to other conditions, such as perimenopause or autoimmune disorders.
Initial workup for any female patient with risk factors or symptoms of CVD should include a full medical history, including obstetric history and family history, physical examination (including blood pressure), blood tests (such as lipid profile) and electrocardiography.
Once diagnosed, initial CVD management should include screening for concurrent conditions such as diabetes, hypertension, and menopause. Ongoing management should include lifestyle modification, education, psychosocial support, and close monitoring. In some women, pharmacotherapy may be indicated.
Patients with CVD should be given reliable and understandable information about their condition, tailored to how it might affect their life. Women with CVD should be encouraged to incorporate physical activity into their lifestyle, ideally 30–60 minutes of aerobic activity at least five times per week. Aerobic activity may include walking, gardening or housework, as well as more formal exercise regimes.
The diet should be optimised to reduce the intake of saturated fats and increase the intake of fruit, vegetables, and sources of fibre. Weight loss should be encouraged in all female patients with CVD who are overweight or obese.
Pharmacotherapy may be indicated in some female patients, including antiplatelet agents, antihypertensives, lipid management and anti-diabetic drugs. For women of childbearing age, the teratogenicity of any medications must be considered.
Management plans should be tailored to the individual, considering their reproductive goals, menopausal status and personal choice. Of particular note, the management of menopause should be considered, as this will involve a careful assessment of the risks and benefits of HRT and CVD. Cardiovascular revascularisation may be considered in selected female patients who remain symptomatic despite medical treatment.
In conclusion, cardiovascular disease in women may be underestimated, and women suffer greater mortality than men. Therefore, managing CVD in female patients should include a personalised treatment plan to optimise outcomes, improve quality of life, and provide the best prognosis.
- Dr Samantha Miller, MBChB
Learn more about this topic in the HealthCert Professional Diploma program in Women's Health: fully CPD accredited online women's health training for GPs, quality-assured by Bond University.
References
1. Lucà F, Abrignani MG, Parrini I, et al. Update on Management of Cardiovascular Diseases in Women. J Clin Med. 2022;11(5):1176. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8911459/
2. Saeed A, Kampangkaew J, Nambi V. Prevention of Cardiovascular Disease in Women. Methodist Debakey Cardiovasc J. 2017;13(4):185-192. doi:10.14797/mdcj-13-4-185 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935277/
3. European Society of Cardiology. Cardiovascular Disease in Women: Reducing the gender gap in prevention, diagnosis and treatment of cardiovascular disease https://www.escardio.org/The-ESC/Advocacy/women-and-cardiovascular-disease
4. British Heart Foundation: Women and Heart Disease. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease
5. World Health Organisation: Cardiovascular Diseases. https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
6. Banks E, Welsh J, Joshy G, et al. Comparison of cardiovascular disease risk factors, assessment and management in men and women, including consideration of absolute risk: a nationally representative cross-sectional study. BMJ Open 2020;10:e038761. doi: 10.1136/bmjopen-2020-038761 https://bmjopen.bmj.com/content/10/12/e038761
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