Recent research suggests that ignoring sex-specific risk factors of heart disease has resulted in women having a higher risk of dying from heart failure than men.

Differences between men and women may mean that the latter do not receive the right treatment for heart conditions.
A review published in Nature Medicine reveals an alarming failure to successfully treat cardiometabolic disorders, such as diabetes, heart disease, and stroke, in women.

The authors urge health services to consider the biological differences between men and women when treating heart disease.

The review, by Prof. Eva Gerdts, of the University of Bergen, in Norway, and Prof. Vera Regitz-Zagrosek, of the Charité Universitätsmedizin Berlin, in Germany, compares the common risk factors for both sexes.

“Men and women have different biologies, and this results in different types of the same heart diseases. It is about time to recognize these differences.”

Prof. Eva Gerdts

The authors summarize the results of over 18 major studies that have explored the causal factors of heart disease in each sex.

The overwhelming finding was that women are more at risk of receiving the wrong treatment because health service professionals fail to spot symptoms or risk factors that are unique to women.

Obesity at the heart of it
Recent research has substantiated fears that the global rise in cardiometabolic disorders is linked to obesity. Meanwhile, fresh evidence suggests that obesity and associated damage to the heart occur differently in men and women.

Global figures show that obesity in women is on the rise, and as Prof. Gerdts’ review explains, women store fat differently from men. The mechanisms behind this process combine to create an increased risk of type 2 diabetes and heart disease.

“If we see this from a life span perspective, we can see that obesity increases with age and that this trend is greater for women than men. Obesity increases the risk of having high blood pressure by a factor of three. This, in turn, increases the risk of heart disease,” explains Prof. Gerdts.

The estrogen advantage
The hormone estrogen works to impede metabolic syndrome by preventing connective tissue from forming in the heart. This also helps keep blood pressure stable.

But the decrease in estrogen that occurs during menopause can increase the risk of arterial stiffening and subsequent disease.

This helps explain an increase in hypertension among women over 60. In men, meanwhile, hypertension is more common before the age of 60.

Lifestyle risks increase with age
Socioeconomic status and lifestyle factors also play a role in cardiovascular risk discrepancies.

The researchers highlight the fact that, around the world, women are more likely to experience low levels of education, low income, and joblessness, and that studies have associated each of these factors with diabetes and depression — two major contributing factors for heart disease.

Meanwhile, the adverse effects of unhealthful habits, such as smoking — which is on the rise in women — multiply as we age. This can lead to high blood pressure, which can cause heart failure if a person does not receive treatment.

“For women, the effects of risk factors such as smoking, obesity, and high blood pressure increase after menopause,” says Prof. Gerdts.

What can we do?
Prof. Gerdts hopes to incite action among the medical community; she calls for healthcare providers to place more emphasis on sex differences when treating cardiometabolic disorders.

“Heart disease remains among the most common cause of death and reduced quality of life in women. Medically speaking, we still do not know what the best treatment for heart attack or [heart] failure is in many women. It is an unacceptable situation.”

Prof. Eva Gerdts

The present study highlights an imbalance in available research, in an effort to pave the way for further work.

The outlook is promising if we consider that cardiac arrest — which is more common in men — is now treatable and preventable. If the same resources and research were applied to the factors that put women at risk of heart failure, perhaps similarly effective interventions could be developed in the near future.

In the meantime, it is important for healthcare providers to help women in high-risk groups lower their blood pressure, reduce the risk or effects of obesity, and put quitting smoking at the top of their list of 2020 goals, if necessary.