These conditions are among the leading causes of morbidity and mortality worldwide, affecting both men and women. However, there are particularities when it comes to the female population, both in terms of the manifestation of CVD and risk factors and treatments.

1. Differences in clinical manifestation

Women may experience more atypical symptoms than men, especially in events such as MI. Instead of typical chest pain, women may experience symptoms such as extreme fatigue, shortness of breath, nausea, back, jaw, or neck pain, which can be mistaken for other non-cardiac conditions.

Women may also be less likely to recognise these symptoms as being heart-related, which can lead to a delay in diagnosis and treatment.

2. Impact of hormones

Female sex hormones, especially oestrogen, have a protective role against CVD throughout much of a woman's reproductive life. Oestrogen can help maintain lower cholesterol levels and promote vascular health.

However, after menopause, its production decreases significantly, increasing the risk of CVD in older women and making them more susceptible to heart disease.

3. Specific risk factors

Menopause: The reduction in oestrogen levels after menopause accelerates the risk of CVD in women. Early menopause, especially when induced by surgery or treatments such as chemotherapy, can further increase the risk.

Pregnancy: Some conditions that occur during pregnancy, such as gestational hypertension, preeclampsia, or gestational diabetes, may predispose women to a higher risk of CVD in the long term.

Use of hormonal contraceptives: The use of oral contraceptives may increase the risk of high blood pressure, thrombosis, and cardiovascular events, especially in women who have other risk factors, such as smoking and hypertension.

Metabolic disorders: Women with metabolic syndrome (which includes factors such as obesity, hypertension, high glucose levels, and dyslipidaemia) are at increased risk of cardiovascular disease.

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4. Mortality and survival rate

Although women tend to develop CVD later in life than men, they generally have a higher mortality rate after an MI or other cardiovascular event. This may be related to reduced awareness of symptoms, longer delays in treatment, and differences in response to treatment.

Additionally, women have a higher prevalence of comorbidities, such as diabetes and hypertension, which can complicate the treatment and recovery of cardiovascular diseases.

5. Treatment and diagnosis

CVD treatments are often based on studies conducted predominantly in men, which can lead to a less optimal approach for women. Responses to treatment, such as medication (e.g., aspirin, statins) or interventions such as coronary stents, may vary by sex.

Early diagnosis and intervention in women may be more challenging due to the atypical presentation of symptoms and lower public awareness of the prevalence of heart disease among women.

Common and specific risk factors in women

Smoking: Smoking is one of the main risk factors for CVD and, in women, it has an even more harmful effect when combined with the use of oral contraceptives.

Obesity: Obesity has a direct impact on cardiovascular health, with women at increased risk due to the prevalence of abdominal obesity, which is associated with increased cardiovascular risk.

Stress and psychosocial factors: Women may be more affected by psychological and emotional stress, which has a direct impact on cardiovascular health. Furthermore, stress can contribute to risky behaviours, such as poor diet and a sedentary lifestyle.


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