A new study has found that women are more likely than men to develop heart failure or die within five years after suffering a heart attack. Additionally, data suggests that a woman’s risk of heart failure is enhanced during the time leading up to menopause.
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Both the research paper and scientific statement were published this month in the journal Circulation. They highlight the importance of developing better prevention strategies for women, and growing public awareness of the fact that heart disease is not something that mostly impacts men.
Heart disease is not a man’s disease
It is a common misconception that men are at a greater risk of suffering a heart attack. It is also often believed that men are at a greater risk of dying following a heart attack. However, heart attacks are the number one cause of death in women in the US, according to the Centers for Disease Control and Prevention (CDC), with heart disease accounting for 1 in 5 female deaths. Because of the misconception about heart disease, many women remain unaware of the risks it poses to them, with only around half of women recognizing it is their number 1 killer.
To investigate the differences between men and women in their vulnerability to heart failure following a heart attack, a team at the Canadian VIGOUR Centre at the University of Alberta collected data from over 45,000 patients who had been hospitalized between 2002-2016 following a first heart attack.
The team looked specifically at ST-segment elevation myocardial infarction (STEMI), a severe heart attack that can often lead to fatalities, and Non-STEMI or NSTEMI, a less severe type of heart attack which is more common. Data was collected from the patients in the study for an average of 6.2 years.
Overall, the team found that women were at an elevated risk of heart failure following a heart attack. They also found that the women in the study tended to be older, and also faced numerous health complications and other risk factors that may have contributed to heart failure.
The study’s lead author, Justin A. Ezekowitz, highlights the study’s importance and relevance in helping to develop future preventative strategies, ”identifying when and how women may be at higher risk for heart failure after a heart attack can help providers develop more effective approaches for prevention.”
Menopause enhances the risk of heart disease
A statement released by the American Heart Association this month has highlighted the transition period into menopause as one key risk factor that may be putting women at an increased risk of heart failure.
Samar R. El Khoudary, Ph.D., M.P.H., FAHA, chair of the statement writing committee and associate professor of epidemiology at the University of Pittsburgh’s Graduate School of Public Health and the Clinical and Translational Science Institute, highlights how our knowledge of the link between menopause and cardiovascular disease has rapidly developed in recent years, “over the past 20 years, our knowledge of how the menopause transition might contribute to cardiovascular disease has been dramatically evolving”.
We now know that at the time women begin the transition into menopause, their bodies start producing less estrogen. Studies have shown that this hormone may have cardio-protective effects, and, therefore, its reduction at the transition into menopause may put women at an enhanced risk of cardiovascular disease.
Khoudary comments that the body of evidence the scientific community has gathered needs to be carefully considered to leverage it into real, impactful strategies to protect women from the risks of heart disease, “we have accumulated data consistently pointing to the menopause transition as a time of change in cardiovascular health. Importantly, the latest American Heart Association guidelines that are specific to women, which were published in 2011, did not include the data that is now available on menopause as a time of increased risk for women’s heart health”.
There is much work to be done to change the public and clinical perception that cardiovascular disease is more prominent in men. This misconception often leads to women receiving less aggressive treatment strategies and being underrepresented in clinical trials, which may contribute to their enhanced risk of heart failure following a heart attack.
In addition, women should be made aware of their risk of cardiovascular disease, and interventions need to be established to protect those who are most at-risk, such as women transitioning to menopause.
- El Khoudary, S.R., Aggarwal, B., Beckie, T.M., Hodis, H.N., Johnson, A.E., Langer, R.D., Limacher, M.C., Manson, J.E., Stefanick, M.L. and Allison, M.A. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation.