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Aging, Systemic Disease and Oral Health: Implications for Women Worldwide (Part I)

Course Number: 302

Cardiovascular Disease: No Longer a “Man’s” Disease

The media has typically portrayed cardiovascular disease (CVD) as a “man’s” disease and has clouded the importance and significance of CVD in women until now. CVD - including coronary heart disease, high blood pressure, and stroke - is now the leading cause of death among American women. It is followed closely by cancer. Heart Disease is the leading cause of death for women in the U.S. and can affect women at any age, with over 60 million women experiencing some form of heart disease.

In 2018, heart disease was responsible for more than 1 out of every 5 deaths for women in the U.S.6 According to the 2021 Heart Disease & Stroke Statistical Update Fact Sheet for Females and Cardiovascular Diseases by the American Heart Association, in 2018, cardiovascular disease (CVD) was the cause of death in 420,164 females of all ages, representing 48.4% of deaths from CVD. The same report also states that in 2018, CVD was the disease with the highest percent of total deaths for all subgroups of females; 30.3% of all non-Hispanic White female deaths, 32.6% of non-Hispanic Black female deaths, 28.3% of Hispanic female deaths, and 31.3% of non-Hispanic Asian female deaths.7 

Based on data from 1995 to 2012, 23% of females age 45 and older who had an initial recognized myocardial infarction (MI or heart attack) died within a year compared with 18% of males. However, within 5 years after a first MI, 36% of males and 47% of females died. Females have MIs at older ages than males do and they’re more likely to die from them within a few weeks. Heart attacks in women under the age of 50 are twice as fatal as in men, and women are more than twice as likely to die within a few weeks from the heart attack versus men.8 It is important to note that this is not due to any inherent biological differences between men and women. Rather, it is due to a combination of factors such as delayed diagnosis, lack of awareness of symptoms, and less aggressive treatment. 8 Approximately 46% of women who survive heart attacks become disabled by heart failure in six years,8 while 64% will die suddenly.9 Ischemic heart disease will account for 3.4 million and approximately 3 million women will die yearly from stroke and a remaining 2.2 million will die from hypertensive heart disease, rheumatic heart disease, and inflammatory heart disease.9 In fact, heart disease kills more women each year than all cancers, chronic lung disease, pneumonia, diabetes, traffic accidents and AIDS combined.9

A global study reported that women are less likely to have heart disease and die of it, than men.10 Current trends indicate CVD and stroke, the first and second leading causes of death globally; will be responsible for increasing deaths and disabilities worldwide, and the number of fatalities is expected to increase to 20 million yearly. By 2030, the rate is estimated to be 24 million.11

Fortunately, CVD is beginning to decrease in many developed countries due to factors such as public prevention programs and medical advances. However, the lower socioeconomic groups in developed countries have a greater prevalence of risk factors, higher incidence of disease, and higher rates of mortality exist. People living in low and middle-income countries often do not have the benefit of primary health care programs for early detection and treatment of people with risk factors for CVD, and have less access to effective and equitable health care services.

According to a new study, half of Canadian women who experience a heart attack have their symptoms go unrecognized.12 Women who suffer from a heart attack are less likely than men to obtain the treatments and medications needed in a timely manner, and are more likely than men to die in the year following a heart attack.12 Women who experience STEMI or NSTEMI, two of the three main types of heart attacks, are more likely than men to die or develop heart failure in the subsequent five years. As well, women who endure a stroke are at higher risk of dying than men.12

2023 Spotlight on Women’s Heart and Brain Health

Figure 2. 2023 Spotlight on Women’s Heart and Brain Health12

Cardiovascular disease (CVD) is the leading cause of mortality in Europe and globally and creates a substantial economic burden for health systems.13 Existing cardiovascular conditions greatly increased the negative effects of Covid-19 infections, and research has shown that pre-existing cardiovascular conditions are extremely relevant predictors of Covid-19 severity and mortality.13 According to a study funded by the British Heart Foundation and carried out at the University of Leeds, women have a 50% higher chance than men of receiving the wrong initial diagnosis following a heart attack.14 The study found that almost one third of patients had an initial diagnosis which was different than their final diagnosis. Women who were misdiagnosed had about a 70% increased risk of death after 30 days compared with those who had received a consistent diagnosis, and also in men.14

Image: Hypertension – Spotlight on Latin America, South Africa and Asia.

Figure 3. Hypertension – Spotlight on Latin America, South Africa and Asia.

From a historical perspective, CVD in men has overshadowed some sex and gender differences related to its diagnosis, presentation, and treatment. Biologically, women have smaller hearts than men, making diagnosis and treatment more challenging, and hormonal changes may affect a woman’s risk for coronary heart disease.15 Symptoms of a heart attack can be very different between individuals, but especially for men and women. The most common signs of a heart attack are the same for both, such as shortness of breath, sweating, pain in the chest, neck, or arms. Women can present with additional subtle symptoms unrelated to those classic symptoms, such as unusual fatigue, nausea, anxiety, uncomfortable pain between the shoulder blades, and sleep disturbance. Men will typically describe chest pain as “crushing” rather than women referring to an “aching or squeezing.”16

Chart listing the heart attack symptoms of men vs women.

Figure 4. Heart Attach Symptoms

Image Source: Temple Health16

Oftentimes these signs are associated with stress and panic disorders and, consequently, lead to a misdiagnosis and/or mistreatment of a potentially serious and deadly condition. Some treatments may be less aggressive for women due to their age, since heart disease is often diagnosed in their later years when estrogen production has diminished.16