Cardiovascular Disease In Women

Introduction

• Description: Disease and dysfunction of the heart and vascular system, including coronary heart disease (CHD, 30%–50% of cases), atherosclerosis, heart failure, hypertension, cardiomyopathy, aneurysm, and stroke.

• Prevalence: Cardiovascular disease (CVD) is the number one killer of American women—annual deaths from CVD are 10-fold those of breast cancer. It is estimated that 48% of persons ≥20 years of age in the United States have early-stage CVD. In the United States, disease and dysfunction of the heart and vascular system is now the leading cause of death in pregnant women and women in the postpartum period (26.5% of US pregnancy-related deaths).

• Predominant Age: Prevalence increases with age for both males and females.

• Genetics: Familial cardiovascular patterns, male sex, 46 single nucleotide polymorphisms (SNPs) across the genome, which are significantly associated with an increased risk, such as MYH7 for cardiomyopathy and those on locus 9p21, which have shown the strongest association.

Etiology And Pathogenesis

• Causes: Multifactorial. Others specific to the disease process.

• Risk Factors: Smoking, diabetes mellitus, hypercholesterolemia/dyslipidemia, obesity (body mass index ≥35), hypertension (these five risks are responsible for more than half of cardiovascular mortality), substance use, anemia, collagen vascular disease, chemotherapy, sedentary lifestyle, abnormal sleep duration (short or long), mild to moderate kidney dysfunction. For women: Non-Hispanic Black race (3.4-fold increased risk), age >40 years (maternal death for this group is 30-fold over that at age 20), pre-eclampsia, premature menopause (<40 years), spontaneous pregnancy loss, breast cancer. Greater than 90% of all CHD/myocardial infarction events occur in individuals with at least one risk factor. Lactation is associated with reduced risk.

Signs And Symptoms

• Acute chest pain (myocardial infarction)

• Acute abdominal pain (aortic dissection)

• Back pain (aortic dissection, myocardial infarction)

• Dyspnea (heart failure, myocardial infarction)

• Elevated blood pressure (hypertension)

• Face drooping (stroke)

• Headache (stroke)

• Intermittent claudication (peripheral vascular disease)

• Orthopnea (heart failure)

• Palpitations (arrhythmia, myocardial infarction)

• Peripheral edema (heart failure)

• Speech difficulty (stroke)

• Syncope (myocardial infarction, stroke)

• Unilateral arm weakness (aortic dissection, stroke, myocardial infarction)

Diagnostic Approach