When is there cardiovascular risk in women?
By Dr. Juan Felipe Salazar
All people are at cardiovascular risk, but in the case of women the risk is higher after menopause.
Having had hypertensive disease during pregnancy and having taken contraceptives chronically, the risk is considerably increased compared to that of men.
What is cardiovascular risk?
This is the percentage risk that a person has of suffering a major cardiovascular event (myocardial infarction, stroke, peripheral arterial disease) at a given time in his or her life, and up to 10 years after the time of calculation. In the case of this article, we will discuss the specific risk for women.
The AHA (American Heart Association) in 2007 established that the 10-year Framingham score predicted the risk of coronary heart disease in more than 20% of patients and could be used to identify a woman at high risk. The current classification is:
- High risk: presence of documented major cardiovascular event, Diabetes, Chronic or end-stage renal disease.
- At risk: presence of ≥1 major cardiovascular event risk factor, metabolic syndrome, subclinical evidence of major cardiovascular event.
- Not at risk (Ideal Cardiovascular Health): absence of major vascular disease risk factors, and a healthy lifestyle.
Despite this, many women tend to omit the presentation of symptoms associated with acute myocardial infarction as they have been described to tolerate chest pain.
Many women ignore the symptoms. The form of clinical presentation is often not typical which can be confusing to physicians and all of this has been linked to low awareness of heart disease.
Substantial progress has been made in the knowledge, treatment and prevention of major cardiovascular event (MACE) in women since the first women-specific clinical recommendations for the prevention of cardiovascular disease were published by the American Heart Association (AHA) in 1999.
The rate of public awareness of cardiovascular disease as the leading cause of death among women in the United States has increased from 30% in 1997 to 54% in 2009.
Awareness of heart disease as the leading cause of death among women is suboptimal and an awareness gap exists between whites and racial/ethnic minorities.
It is well established that delay in seeking emergency services is associated with higher rates of cardiac mortality.
Investment in the fight against this major public health problem for women has been significant, as have scientific and medical achievements.
Current data suggest that the level of awareness of heart disease as a leading cause of death among women has nearly doubled since 1997 and has remained stable over the past several years.
Awareness among racial and ethnic minorities has increased significantly (although it remains lower compared to Caucasians), while the awareness gap among younger versus older women has narrowed.
Women have been shown to have a significant time delay in receiving diagnostic and interventional procedures, which may contribute to a worse 30-day mortality rate compared to men.
Given the worldwide health and economic implications of cardiovascular disease in women, there is a strong rationale for sustaining efforts to control major cardiovascular event risk factors and to apply evidence-based therapies in women.
Future directions should consider recommendations for the specific outcomes of cardiovascular disease in women.
Future guidance should consider recommendations for specific outcomes of particular importance in women, such as stroke.