Risks for Cardiovascular Disease in Women
Cardiovascular diseases (CVDs) are currently the primary causes of mortality around the world. The number of lives lost due to CVDs as of 2005 is 17.5 million which is equivalent to 30 percent of the total global mortalities (WHO, 2008). In United States for example, heart disease is the number one cause of death in man and third in women. It is estimated that the annual mortalities due to this condition in US alone is greater than 870,000 (Labarthe, 2008). The data regarding the occurrence of heart diseases in women in Europe like in US also indicate CVDs to be a major cause of mortality in women. Cardiovascular diseases are approximated to have caused 55 percent of European women mortalities (Badiale et. al, 2006). The incidence of cardiovascular disease in women is highly under estimated because of the misnomer that women are less prone to heart diseases as compared to men and that cardiovascular disease pathology in women is the same with those of men. In reality though, cardiovascular disease in women manifest as a condition that have various differences with that of men and older women are more prone to men in having cardiovascular diseases.
Nature of Cardiovascular Diseases in Women
Cardiovascular disease is a collective term for all the diseases of the heart and the blood vessels. This group of diseases includes coronary heart disease; peripheral arterial disease; cerebrovascular disease; congenital heart disease; deep vein thrombosis and pulmonary embolism; and cerebrovascular disease (WHO, 2008). The specific cardiovascular diseases that cause high mortalities in both men and women are coronary heart disease (CHD) and stroke (Labarthe, 2008). Statistics indicate the occurrence of CHD and stroke in women out of all the cardiovascular disease mortalities is 23% and 11% respectively (Badiale et al., 2006). The intensity of the dilemma of heart diseases is not only manifested through the mortality rate but also in the number of individuals suffering from these diseases. Cardiovascular diseases is the leading cause of hospitalizations and the cost of treatments due to this disease conditions in United States is estimated to be greater than $448 in 2008 alone (Labarthe, 2008).
The previous characteristic symptoms of cardiovascular diseases were based on its manifestations in man because mortalities due to CVDs in the past were higher in men than in women. This is also the reason for the precedent underestimation of the occurrence of heart diseases in women and the lack of past awareness of heart diseases among the women population. Women in the past have feared breast cancer than heart attack because of the misnomer that men are the only ones highly affected by heart diseases (Cook, 2005). What the women then failed to realize is that cancer only took 1 life in every 30 women while heart diseases mortality happens in 1 of every four members of the women population. The present trend though of women having increased fatalities due to CVDs as compared to men resulted into medical practitioners considering the CVDs clinical signs in women as characteristics of the disease (Fogoros, 2006). This present trend also is the driving force of various actions regarding the awareness campaigns about cardiovascular diseases in women.
Cardiovascular diseases are often identified only after the occurrence of stroke or heart attack because CVDs frequently have no recognizable symptoms prior to heart attack or stroke. These two conditions are acute in nature and both occur due to a vessel obstruction hindering blood flow. The only difference between these two clinical conditions is that stroke occurs in the brain while heart attack occurs of course in the heart. The blockage of blood flow to heart or the brain also means the disruption of oxygen and nutrient supply of these organs hence the damage of their tissues occurs. The blockage in the blood vessel is often a result of build ups of fats in the inner lining of the blood vessels (WHO, 2008).
There are two types of heart blood flow obstruction: complete and partial. The partial heart blood flow obstruction results to a condition termed as angina which is actually chest pain. Angina does not always lead to permanent heart injury (WHO, 2008). The characteristic symptom of angina in men is often not manifested in women. Descriptions of angina signs in women include hot or burning sensation; and, tenderness to touch in areas like the arms, jaw, back, and shoulders. These clinical signs are deviations from the definition of angina which is chest pains. Misdiagnosis of angina in women is frequently committed by medical practitioners because of the failure to recognize that angina in women does not manifest as chest pains but rather other symptoms (Fogoros, 2006).
Heart attack in women often does not manifest angina or chest pains but in some cases this symptom was also present. The clinical signs observed prior to heart attack in women are: anxiety, sleep disturbance, uncommon fatigue, indigestion and shortness of breath. The most predominant among the aforementioned symptoms is the uncommon fatigue. The observance of these clinical signs is a serious warning of an up coming heart attack thus patients need to seek medical help before it’s too late. The indicated clinical signs observed during heart attacks on the other hand are shortness of breath, weakness, cold sweat, dizziness, and uncommon fatigue (Longley).
Risks Cardiovascular Disease in Women
The realization that there are gender-associated differences of the risks of cardiovascular diseases lead to the identification of the risks factors of CVDs for women. Risk factors of CVDs can be classified into four categories: risks associated with women only; adjustable risks highly associated to women; adjustable risks for both women and men; and the non-adjustable risks for both men and women. Those that belong to the first category – the non- adjustable risks for both men and women are gender, age, heredity, and ethnicity or race (WHO, 2004).
Age is a risk factor in the development of CVDs in women. The age wherein women are prone to the development of heart diseases varies from one woman to another because the age at risk of CVDs is post menopause stage wherein there diminished amounts of estrogen in the body is present. Along with the lowering amounts of estrogen goes their beneficial effect in maintaining the cardiovascular health. The beneficial effects of estrogen that are lost during menopause include sustaining of high-density lipoprotein (HDL) or “good” cholesterol and the relaxation of arteries’ smooth muscles. The adequate amounts of HDL is important in blood vessel health because it combats the low-density lipoprotein (LDL) or “bad” cholesterol that builds up in the inner lining of blood vessels and eventually causing blood flow obstruction leading to heart attacks. The capacity of estrogen to elicit relaxation of arteries’ smooth muscles on the other hand is important in regulating the normal blood pressure and preventing blood vessel damage (NINR).
Along with age another non-adjustable risk factor is gender. The present trend now is women having higher risks of developing cardiovascular diseases as compared to men. Thus, being a woman already has percentages of risks of CVDs development. This risk factor coupled with other factors will amplify the degree of susceptibility to heart ailments. Women should be aware of this reality and if they identify themselves with other risk factors prompt consultation to heart specialists of their health care provider must be done. The sad reality in the provision of health care for cardiovascular diseases though is that women are disadvantaged in obtaining these services. The admittance to hospitals, acquisition of treatments, and utilization of diagnostic equipments among women especially in developed countries is lesser than that of men (WHO, 2004). These biased treatment of women needs to be addressed first before the problem of high heart disease affliction and mortality in women can be solved.
One more risk factor for the development of CVDs that can not be modified is heredity. Just like other hereditary disease such as diabetes, any history of heart ailments in the family of the individual implies that he or she is more likely to develop the disease also. The genetic transfer of disease condition should not be underestimated especially in cardiovascular diseases development. The individual’s family history can either involve the any male member of the family that had heart disease prior to age 55 or any female member that experience heart disease before being 65 years old. Either way the other members of the family needs to be aware that they can develop the disease in the future and undergo preventive measures such as modifying the lifestyle to prevent the overlapping of various risk factors that will result to heart disease (WHO, 2008).
The second category- adjustable risks for both women and men on the other hand include high blood pressure, high total cholesterol level, combined hyperlipidaemia, decreased HDL-cholesterol level, sedentary lifestyle, stress, and unhealthy diet. Increased total cholesterol level is one of primary the risk factors for cardiovascular diseases development that are common to men and women hence the reason why it belongs to category number two. The increase in total cholesterol level from the normal value is directly proportional to the amplification of the risk of obtaining heart diseases and heart attack. Complication of high cholesterol level is highly observed in diabetic individuals which why these people are advised to be vigilant in maintaining low levels of both their cholesterol and glucose blood levels (NHLBI, 2007).
Cholesterol is a substance that is essential for the normal body functioning. This is why the body itself manufactures the cholesterol needed for its functions. Since the body capable of producing its cholesterol need, the cholesterol that people intakes will just accumulate in the blood vessels that supply the heart. This cholesterol accumulation in the inner lining of the arteries is termed as plaque formation. The continuous formation of plaque in the inner lining of the arteries narrows these blood vessels resulting to impediment of the normal flow of blood to heart. The obstruction in turn deprives the heart its needed amount of oxygen that is carried by the blood and some parts of the heart will not be supplied with blood. This condition will then result to heart attack. To prevent the occurrence of this condition the normal levels of cholesterol in the body needs to be properly regulated through having healthy diet (NHLBI, 2007).
Sedentary life style is one more predisposing factor to the occurrence of heart diseases. Increased risk of heart diseases and stroke has been noted in individuals that lack physical activities. This physical activity is much needed by the body to strengthen the bones and heart muscles; reduce stress which is also a risk factor of heart diseases development; enhancement of blood circulation and muscle tone; lowering blood pressure; reducing weight to prevent obesity, another risk factor; and increased the amount of oxygen in the body. An individual’s daily physical activity need not be a rigorous one. Instead, it can be as simple as walking, doing house chores, jogging, and gardening (WH0, 2008).
Another component of this category of cardiovascular risk factors is the custody of an unhealthy diet. This can complicates with lack of physical activity that will result to obesity. By unhealthy diet we are referring to great increase of intake of calorie than that needed by the body; excessive intake of sugary, salty, and fatty foods; and inadequate amounts of fruit and vegetables intake. Eating amounts greater than the need of the body is especially a problem because the food consumed will just be converted to body fats if the individual also lacks exercise. Too much body fats like in obese individuals complicates with diseases like diabetes and then result to heart attack or stroke (WHO, 2008).
The third category- adjustable risks highly associated to women involve tobacco use or smoking, high triglyceride levels, diabetes, depression, and obesity. The elevated amount of bad cholesterol is among the primary risk factors in the progression of heart disease both in men and women. Transportation of cholesterol in the blood occurs through substances termed as lipoproteins. The cholesterol is classified according to the type of lipoproteins that transport them in the blood, hence the two types: low density lipoprotein (LPL) and high density lipoprotein (HPL). LPL is also called the bad cholesterol while the HPL is the good cholesterol. The term bad cholesterol is coined to the LPL because this type are the ones that accumulate in the inner lining of the blood vessels that will eventually cause heart attack due to impediment of blood flow to the heart. Adequate balance in the amounts of LPL and HPL in the body needs to be maintained to prevent the excessive cholesterol plaque formation in the blood vessels (NHLBI, 2007).
Another risk factor that belongs to the adjustable risks highly associated to women is the utilization of tobacco. Smoking in women result to their 2-6 fold increased chances of having heart attacks as compared to women that do not smoke. Increase in quantity of cigarette sticks smoked by a woman also proportionally amplifies the threat of heart attack occurrence. The life expectancy of smoking women in comparison to those whom are non-smokers is lesser than 10 years because of the development of intensive heart ailments. The smoking women’s risk of obtaining heart attack comes along with the risk of having stroke (NHLBI, 2007).
Aside from cardiovascular diseases development, smoking is also a high risk factor in the development of other diseases like cancers of the mouth, lungs, and urinary tract. Smokers not only compromise their own health because the healths of those people around them are also equivalently threatened due to second hand smoke inhalation. It is approximated that an increase of 20 to 30 percent in the risk of developing heart ailments is ensues the people that inhale the second hand smoke in their residences or in the workplace. Even smoking in moderation is not healthy at all because every stick is detrimental to the health of the smoker and the people around them. Thus, there is no such thing as smoking in moderation and the best measure to preserve your health and the individuals around you is to stop smoking (NHLBI, 2007).
Finally, the fourth category – risks associated with women only include utilization of oral contraceptive, hormone replacement therapy, having polycystic ovary syndrome, and early menstrual cycle (WHO, 2004). In the past it has been the common knowledge that hormone therapy will aid in lowering the risk of cancers and heart diseases occurrence. Recent studies though indicate otherwise. These hormone therapies are even risk factors for the development of heart diseases. Thus, it is not advisable for menopausal women to undergo hormone therapy as preventive treatments for cancer and other diseases (NHLBI, 2007).
Aside from the risks factors that are included in the four categories, women that are afflicted with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are also highly prone to the development of cardiovascular diseases. HIV/AIDS, its etiologic agent, and the therapeutic regimen received by the patient of this disease is not the direct cause of the development of CVDs but the improper redistribution of body fats in these individuals which is a effect of HIV/AIDS and its therapies. Fat accumulation in organs of the body that can eventually lead to fat obstruction in the heart and blood vessels is an effect of HIV/AIDS progression and its treatments. High blood levels of triglyceride and glucose which are risk factors for the progression of CVDs are exceedingly observed in HIV/AIDS patients (Gadd, 2005). The increased risk of women HIV/AIDS patients to CVDs development is reason enough for these HIV/AIDS patients to take precautionary measures to prevent having CVDs.
Gender Differences of Cardiovascular Diseases Risks
Fatality of heart diseases in women is higher by 1.7 times as compared to men (Hsia, 2007). This alone already suggests that there are gender differences in the occurrence of heart ailments in the two genders. The gender differences though are not limited to the mortalities and morbidity of heart diseases in men and women. Included in the gender differences of the nature of heart diseases are the risk factors. Some risk factors highly predispose women to cardiovascular diseases development while other risk factors have increased association to men. And though some risk factors are similar in both men and women, certain specific details of these risk factors are different for both genders (Badiale et al., 2006).
The primary example for a risk factor with significant similarities and differences in both genders is age. It is true for both genders that the prevalence and incidence of the development of heart diseases elevates along with age. Yet, on the average women are older than men by 10 years upon their affliction with CVDs. Mostly, women are only afflicted with heart attacks at ages lower than 65 while in men heart attacks or other heart diseases occurs at ages below 55 years old. Men then tend to develop cardiovascular diseases earlier than women. The emergence of the risk factors in the age of both genders also differs. For example, in comparison with men, higher numbers of women acquire hypertension during post -45 years old (Badiale et al., 2006).
Increased total level of body cholesterol is both a risk factor in men and women but there are also gender differences in relation to this risk. The gender difference is that men after age 55 tend to have lower levels of cholesterol while women reach peak levels of increased cholesterol levels only during ages 55 to 65. In both genders, the elevated levels of blood cholesterol can be alleviated by the administration of lipid-lowering agents. The provision of appropriate treatments for this condition though is not obtained by bulk of the women population whom are exceedingly at risk (Badiale et al., 2006).
Cardiovascular diseases once developed in an individual can only be managed through various procedures but can never be cured. Even the advances in medical technology like by pass surgeries and angioplasty are not capable of curing this disease condition but instead are only heart disease management procedures. After the heart diseases progression, the arteries have already been damage therefore the likelihood of heart attack occurrence is a life long threat in CVDs patients (NHLBI, 2007).
Since cardiovascular diseases are life time conditions, every individual’s best weapon against these diseases is the institution of preventive measures. There are risk factors that can never be adjusted but the rest can be changed. People need to be aware enough to modify their life styles to accommodate the prevention of heart diseases development if they do not want to suffer the disease in later age. An individual’s risk of obtaining heart disease can be significantly decreased through simple methodologies such as maintaining low levels of cholesterol by eating healthy foods, quitting smoking, and exercising at a regular basis (NHLBI, 2007).
The association of women to increased number of risk factors to the development of cardiovascular diseases as well as the greater prevalence and incidence of heart diseases among women only implies that women should not underestimate her gender’s risks of the development of heart ailments. Every woman needs to be aware of the risk factors of CVDs development and practice precautionary measures to prevent from being afflicted from such diseases. The health providers also needs to be aware that at present more women are afflicted with heart disease and should work towards the provision of the health care for women heart diseases patients. It does not mean though that since women have increased tendencies of acquiring heart diseases men should just forget that they can also be afflicted with heart disease. Despite the gender differences of the risk factors, the battle against heart diseases is fight for both men and women.
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