Epidemiology and risk factors

The fact that cardiovascular disease (CVD) is the number one killer of European women is still not widely known, nor is that women are disadvantaged in terms of risk assessment, diagnosis, prognosis and treatment.

CVD is the biggest cause of death in European women, accounting for 40% of all deaths- twice as much as all cancers combined. Coronary heart disease (CHD) and stroke together are TEN times commoner than breast cancer, yet many women -and indeed health professionals- appear unaware of this.

Risk of cardiovascular disease in both sexes is related to age, smoking, blood cholesterol level and blood pressure; while women develop CVD ten years after men, it is more lethal when it occurs one year after a heart attack (42% of women will be dead, compared to 24% of men). A woman with multiple risk factors loses her “age advantage” and may be at higher risk than a man the same age. Diabetes is a particularly potent risk factor in women.

Diagnosis and Treatment

Women are less likely to be investigated for heart disease, diagnosed correctly, referred for specialist investigation, offered revascularization, have adequate risk factor assessment or be offered appropriate drug therapy such as aspirin, beta-blockers and cholesterol lowering medication. They are seriously under-represented in therapeutic trials, resulting in a less adequate evidence base for treatment.

New Points from the Conference

• Women are less likely to be offered percutaneous interventions (angioplasty and stents) than men and do less well when they do receive them. Underutilization of drug treatments has been confirmed.
• Young female diabetics are at high risk, and have a disproportionately high mortality when they do get a heart attack.
• Women who have an out of hospital cardiac arrest are less likely to survive than men.
• Women with chest pain and apparently normal coronary arteries on coronary angiography may have severe atherosclerosis when assessed with intravascular ultrasound (IVUS). They develop more acute coronary syndromes (heart attacks and unstable angina) over follow-up than men.

Conclusions

There is a major need to communicate these findings to the public, health planners and indeed health professionals. More research is needed into the clinical presentation of CVD in women and why health professionals and indeed perhaps women themselves seem to underestimate the problem. Therapeutic trials planners need to recognize that CVD is, if anything, a bigger problem for women than men. New detection and management strategies are needed, and new recommendations on CVD evaluation, prevention and management need to reflect this new knowledge. Ultimately, as with all aspects of CVD prevention, the challenge is to “de-medicalise” the problem and make self risk assessment and management accessible to all from childhood on.