Women at Cardiovascular Risk

Summarized by Robert W. Griffith, MD
October 7, 2002 (Reviewed: October 19, 2004)

Introduction

Young women are much less likely to have high blood pressure than men - about half as likely - but this 'hypertension gap' begins to narrow from the age of 30 onwards.¹ With the onset of menopause, the gap is all but gone, and by the time they are in their 60s, women with high blood pressure outnumber men, 60% to 40%. At this age, the main type of high blood pressure encountered is isolated systolic hypertension (ISH), where the systolic pressure is over 140 mmHg but the diastolic is below 90 mmHg.²

People with ISH often have a high pulse pressure (PP, the difference between the systolic and the diastolic pressure), and the two of them - ISH and PP - are both known to be specifically related to coronary heart disease (CHD).

Coronary disease in women

It's often thought that CHD isn't really a problem in women, but that's a fallacy. In the USA, CHD is the leading cause of death in women, being responsible for more deaths than the combined total of deaths from breast cancer, lung cancer, and stroke. Probably because of the 'lag' in the occurrence of high blood pressure in women, as described above, the increasing rates of CHD and heart attacks occur later in life women than in men. However, the women soon 'catch up', as their rates increase at a greater rate.

Heart attacks in women

Another gender difference relates to the severity of heart attacks. When women have a heart attack (myocardial infarction, or MI), the amount of heart muscle destroyed is likely to be larger, and they are more liable to go into shock, heart failure, and to die, than men.

Risk factors for CHD

The risk factors for CHD are the same in men and women, although men usually take more exercise, drink more alcohol, and have lower levels of the blood clotting factor, fibrinogen. On the other hand, pre-menopausal women are 'protected' to a certain extent degree by their hormone levels (specifically, estrogen).

However, the effect of diabetes as a risk factor is clearly different in women and men. Women with diabetes have twice the risk of CHD as same-age non-diabetic men, and almost four times the risk compared with non-diabetic women. This extra risk in women diabetics may be due to their tendency to have lower HDL-cholesterol levels (the 'good' cholesterol), higher triglyceride levels, higher blood pressure, and an increased size of the left main heart chamber (the left ventricle).

The metabolic syndrome in women

As many as 48% of CHD events (heart attack, sudden heart death, unstable angina are seen in women with three or more CHD risk factors, compared with 30% in men with similar risk factors. It seems that risk factors accumulate, often starting with overweight, progressing to obesity. When blood lipid problems, high blood pressure, and disturbances of blood glucose metabolism are added, the 'metabolic syndrome' (also known as Syndrome X) is present - see the link below.

Women who have the metabolic syndrome no longer have a gender advantage over men with regard to CHD. What is more, there are reports that high blood pressure in elderly women is more likely to cause a stroke or chronic heart failure than in men.

Consequences?

Drug treatment of high blood pressure is equally effective in men and women. However, screening for high blood pressure is generally poor; many opportunities to measure blood pressure are missed. For instance, although most women visit their gynecologist for an annual check-up, their blood pressure may not routinely be part of the visit. It seems that women with hypertension don't get diagnosed or treated adequately as often as men. While a healthy lifestyle - weight control through exercise and a sensible diet, not smoking, alcohol in moderation - will lower the risk of CHD, continued high blood pressure requires recognition and adequate drug treatment, particularly in women.

Source

• Definition and epidemiology of hypertensive cardiovascular disease in women: the size of the problem. SS. Franklin, J Hypertens, 2002, vol. 20, pp. 3--5

Footnotes
1. High blood pressure (hypertension) is defined as systolic pressure (the first number) being 140 mmHg or above, the diastolic pressure (second number) being 90 mmHg or above, or the subject receiving anti-hypertensive medication.
2. The systolic pressure is the peak pressure reached when the heart beats; the diastolic is the pressure when the heart relaxes between beats. Blood pressures less than 120/80 mm Hg (systolic/diastolic) are usually considered ideal.

Related Links
Syndrome X -- Again!
Today, Women's Angioplasty Results Equal Men's
What's Your Blood Pressure and How Do Blood Pressure Medications Work?
Women: Consider Heart Healthy Changes Before the 'Change'

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