GET THE APP

How to Reduce the Burden of Coronary Heart Disease in Women?
Journal of Women's Health Care

Journal of Women's Health Care
Open Access

ISSN: 2167-0420

+44-7360-538437

Editorial - (2013) Volume 2, Issue 1

How to Reduce the Burden of Coronary Heart Disease in Women?

Clara Saldarriaga*
University of Antioquia, Medellín, Colombia
*Corresponding Author: Clara Saldarriaga, University of Antioquia, Medellín, Colombia

Coronary heart disease is the leading cause of death worldwide. It is estimated that more than 250,000 women die every year in the United States due to myocardial infarction [1]. This disease causes 50% more deaths than cancer. The incidence of coronary heart disease has remained unchanged in the last decade for women while it has been decreasing in men [2]. How can we explain this difference and what can be done to decrease the burden of heart disease in women?

The first step is to implement governmental policies to increase education on cardiovascular risk, because most women are unaware of the key facts about cardiovascular prevention and how to start a healthy life style. This must be done since early childhood.

The second step must focus on early detection of women at risk, including the evaluation of traditional risk factors, the increasing rates of cigarette smoking, physical inactivity, obesity, hypertension, and metabolic syndrome which have been reported in younger women. Some of these aspects can be modified thus contributing to decrease the incidence of this disease. But traditional risk factors only explain two thirds of coronary events and the Framingham risk score underestimates the risk in the female population. Therefore, novel risk factors are a promising field for research and intervention. For example complications associated with pregnancy like preeclampsia, diabetes, premature delivery and low weight at birth that had been related to premature coronary heart disease, make pregnancy an opportunity to detect women who need closer follow-up after the delivery in order to strictly control their cardiovascular risk [3-5].

The atypical presentation of acute coronary syndrome in women also contributes to the under-diagnosis of the disease. The evaluation of chest pain in women has been hampered by attempts to apply a “typical” angina definition derived from predominantly male populations which is why it is necessary to educate the healthcare personnel in order to increase awareness of the symptoms of the disease [6,7].

Women with ischemic heart disease also have a worse prognosis. They are more likely to die of cardiac arrest before hospital arrival, have more adverse outcomes, greater symptom burden, higher rate of functional disability compared to men despite higher frequency of non-obstructive coronary disease, this is worsened by differences in treatment between sexes. Recent studies have shown that women are less frequently treated with reperfusion therapy such as cardiac catheterization and medications that have changed the prognosis of the disease resulting in suboptimal management and biases for women in today’s healthcare environment [8-10].

In conclusion, we must change the paradigm of treatment for heart disease in women towards preventing it from early childhood, supporting firm government policies aimed at healthier life-styles in our population, addressing barriers to healthcare access by women and stimulating innovative research in coronary heart disease on genderspecific issues in order to decrease the burden of heart disease in the world.

References

  1. Bairey Merz N, Bonow RO, Sopko G, Balaban RS, Cannon RO 3rd, et al. (2004) Women's Ischemic Syndrome Evaluation: current status and future research directions: report of the National Heart, Lung and Blood Institute workshop: October 2-4, 2002: executive summary. Circulation 109: 805-807.
  2. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, et al. (2008) Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117: e25-146.
  3. Haukkamaa L, Salminen M, Laivuori H, Leinonen H, Hiilesmaa V, et al. (2004) Risk for subsequent coronary artery disease after preeclampsia. Am J Cardiol 93: 805-808.
  4. Smith GC, Pell JP, Walsh D (2001) Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet 357: 2002-2006.
  5. Saldarriaga CI, Franco G, Garzón AM, García I, Mejía N, et al. (2010) Risk factors for premature coronary disease in women. Biomedica 30: 559 -566.
  6. Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, et al. (2006) Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 47: S21-S29.
  7. Pepine CJ, Kerensky RA, Lambert CR, Smith KM, von Mering GO, et al. (2006) Some thoughts on the vasculopathy of women with ischemic heart disease. J Am Coll Cardiol 47: S30-S35.
  8. Nohria A, Vaccarino V, Krumholz HM (1998) Gender differences in mortality after myocardial infarction. Why women fare worse than men. Cardiol Clin 16: 45-57.
  9. Johnston N, Schenck-Gustafsson K, Lagerqvist B (2011) Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain? Eur Heart J 32:1331-1336.
  10. Bugiardini R, Yan AT, Yan RT, Fitchett D, Langer A, et al. (2011) Factors influencing underutilization of evidence-based therapies in women. Eur Heart J 32: 1337-1344.
Citation: Saldarriaga C (2013) How to Reduce the Burden of Coronary Heart Disease in Women? J Women’s Health Care 2:e111.

Copyright: © 2013 Saldarriaga C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Top