Cardiovascular disease, the leading cause of death in women

It has long been proven that sex can have a significant influence on the different ways in which men and women become ill. It is true that the traditional risk factors for cardiovascular disease, such as cholesterol, blood pressure and diabetes mellitus, affect both sexes. However, women are protected against the development of these diseases throughout their fertile life thanks to the action of estrogens. It is a natural mechanism that has allowed her to maintain a privileged health situation in the time frame of maternity. In other words, nature prepares and benefits women for the upbringing of their offspring.
Unfortunately, in recent years we have witnessed a disproportionate increase in the incidence of cardiovascular disease (CVD) in women, increasingly at younger ages and with a greater impact on survival. In fact, CVD is already the leading cause of death in women, ahead of cancer and respiratory diseases.
Without adequate knowledge of the situations that can increase cardiovascular risk in women at different stages of their lives, it is difficult to establish appropriate measures and anticipate complications. The concept of “cardiovascular risk” implies the possibility of developing more serious disorders including:
– Coronary artery disease: the mildest form is angina pectoris, but there is also myocardial infarction and sudden death.
– Arrhythmias
– Heart failure
– Cerebrovascular disease: strokes, embolisms and cerebral hemorrhages.
– Venous thrombosis
– Pulmonary thromboembolism

What are the main risk factors in women?

There are several aspects that especially affect women and sometimes they are not so well recognized. Some of the conditions that can characteristically affect women and whose suffering increases cardiovascular risk later in life are:
– Pregnancy disorders:
– Hypertensive states of pregnancy (EHE).
– Gestational diabetes mellitus (GD)
– Placental abruption
– Preterm low birth weight
– Preterm delivery
– Timing of fertility cycles:
– Late menarche
– Early menopause (between the ages of 40 and 50) or premature ovarian failure (menopause before the age of 40). This also includes cases in which it is caused by an intervention such as removal of the uterus or hysterectomy.
– Use of contraceptives: not only because of the hormonal alteration they produce, but also because many of them act on the liver and cause changes in lipid levels (cholesterol, triglycerides).
– Other endocrine-gynecological conditions:
– Polycystic ovary syndrome
– Hypogonadotropic hypogonadism
– Endometriosis
– Sex change treatments

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Early manifestations

The development of these disorders is accompanied by early manifestations of vascular damage. Among them is endothelial dysfunction, more prevalent in women with a history of preeclampsia and repeated miscarriages. This dysfunction may persist and predispose to later vascular complications.
On the other hand, up to 10% of women suffer from secondary infertility, related to conditions such as polycystic ovary syndrome, premature ovarian failure, endometriosis or pelvic inflammatory disease. These conditions could also influence an increased risk of cardiovascular disease.

Recommendations to prevent cardiovascular diseases

The triptych shows some recommendations to be taken into account, which should be discussed with a specialist in Cardiology. Of course, any prevention strategy must be accompanied by correct dietary guidelines, regular physical exercise, absolute abstention from smoking and appropriate management of stress and emotions.