In 2020, there were 244.112 deaths in women according to reports from the National Institute of Statistics at the end of 2021. The main cause of death was the group of diseases of the circulatory system, which accounted for 24,3% (119.853) compared to 22,8. .XNUMX% of deaths from tumors, and ischemic heart disease once again took first place.
There are false concepts, such as that cardiovascular disease is a more common pathology in middle-aged men and that the risk of cancer is greater than that of cardiovascular disease.
Exposure to cardiovascular risk factors is similar in men and women, but there are marked differences in how these affect each group.
Tobacco and Hypertriglyceridemia present a greater risk and are an important cause of atherosclerosis in young women. Diabetes, obesity and depression are more prevalent in women. A sedentary lifestyle is present in 22.4% of women compared to 16,2% of men and inflammatory and immunohematological diseases such as rheumatoid arthritis, lupus, antiphospholipid syndrome and thyroid pathology are more prevalent in women and are associated with accelerated atherosclerosis. and precocious.
Only 45% of women are aware that the main cause of death for them is cardiovascular diseases. Even in the medical community, there is still an erroneous perception that women are less at risk of suffering from cardiovascular pathologies than men. Less than half of family or primary care physicians consider cardiovascular diseases to be important in women.
The endothelium, that layer that lines the interior of all blood vessels, is an essential organ for the control of vascular function and the maintenance of balance in the wall of the arteries, and plays an important role in the development, progression and complications of artery disease throughout the body. It has antiatherogenic and antithrombotic properties, due to the production of some substances such as nitric oxide, with multiple beneficial effects, it inhibits platelet aggregation, it is a vasodilator and anti-inflammatory, and its production is greater in premenopausal women than in men.
Changes in sex hormone concentrations during menopause have effects on insulin resistance, the distribution of visceral and body adipose tissue, and are related to a higher cardiometabolic risk profile.
There is an increase in blood pressure related to the use of combined oral contraceptives (due to the estrogenic component) and when their use is associated with tobacco consumption, the risk of thrombosis increases (mainly in women > 35 years of age).
Polycystic ovary syndrome, present in 5% of women of childbearing age, increases the risk of late onset of cardiovascular disease. Premature menopause, (1% of women under 40 years of age) is also associated with an increased risk.
Complications during pregnancy can be warning signs of future cardiac risk for the mother. Cases of preeclampsia have increased by 25% in
last 2 decades and increases obstetric morbidity and mortality and increases maternal risk of future cardiovascular disease, making them more susceptible to hypertension.
14% of pregnant women will have gestational diabetes, 50% of these will develop diabetes in the next 5 years and 70% after 10 years. Between 10 and 30% of diabetic women have a history of gestational diabetes. The risk of venous thrombosis increases 10 times during pregnancy.
Cardiovascular disease in women, and specifically ischemic heart disease, has been underdiagnosed, and its management and treatment are often inadequate. This is associated with a frequently "atypical" presentation of symptoms, leading to an underestimation of severity and erroneous or delayed diagnosis . Often, the reason for consultation is nonspecific symptoms such as back and jaw pain, nausea, vomiting, dyspnea, fatigue, indigestion, or palpitations.
It is clear that in Europe cardiovascular disease is the leading cause of death in women, but despite this there is no clear awareness of the real severity of cardiovascular pathology in women, and its magnitude has been undervalued. Despite that the risk factors for cardiovascular disease are common for both sexes, the way these affect women is different, they are also less likely to be referred to a specialist, they receive less medication and are less frequently referred to diagnostic or therapeutic studies, late appointments and less favorable development, with higher rates of complications make the problem greater.
Just as there are preventive programs for many medical processes, which achieve prevention, detection and early diagnosis with a better prognosis, it is clear that there is also an increasing inclusion of women in clinical studies and greater knowledge of their differences, but we need specific diagnostic and therapeutic protocols for each sex.
We have the task of involving health professionals, health institutions and women, as they are the most affected by this situation and as active disseminators of information and the benefits of cardiovascular prevention.
By Dr. Alenadro Sáez Ruiz, UICAR cardiologist