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Gender Bias in Cardiovascular Disease Prevention, Detection, and Management, with Specific Reference to Coronary
Shailesh Desai1, Atul Munshi2,3, Devangi Munshi4
1Consulting Preventive Cardiologist, Above Star Bazaar, Satellite Road, Ahmedabad, India.
Insights
Cardiovascular disease (CVD) is a leading cause of death in women, yet misconceptions persist. This review highlights significant gender differences in coronary artery disease (CAD) risk, prevention, and management, emphasizing the need for tailored strategies.
Area of Science:
- Cardiology
- Women's Health
- Vascular Biology
Background:
- Cardiovascular disease (CVD) is the leading cause of death in women, surpassing men annually.
- A prevalent misconception suggests women are less susceptible to CVD, leading to potential underestimation of risk.
- Significant sex-based differences exist in the prevention, investigation, and management of CVD, particularly coronary artery disease (CAD).
Purpose of the Study:
- To review and highlight gender differences in cardiovascular disease (CVD), with a specific focus on coronary artery disease (CAD).
- To address the alarming increase in CAD risk factors and events among women in India.
- To underscore the impact of estrogen decline, metabolic syndrome, and female-specific risk factors on women's cardiovascular health.
Main Methods:
- Literature review focusing on gender disparities in CVD and CAD.
- Analysis of epidemiological data on cardiovascular risk factors in India.
- Examination of biological and vascular factors contributing to sex differences in CAD.
Main Results:
- Coronary artery disease (CAD) incidence is rising alarmingly in Indian women due to increased conventional risk factors.
- Estrogen's perceived protective effect can lead to delayed prevention and management strategies for women's CAD.
- Metabolic syndrome (MetS), prevalent in women (especially postmenopausal), significantly increases future CAD risk.
- Menopause marks a critical transition, increasing CVD risk in women over 55 due to estrogen loss.
- Female-specific factors (PCOS, pregnancy-induced hypertension, gestational diabetes) and vascular differences (smaller vessels, less collateral flow) contribute to women's CAD.
Conclusions:
- There are critical gender differences in cardiovascular disease (CVD) and coronary artery disease (CAD) that require specific attention.
- Misconceptions about estrogen's protection and delayed interventions contribute to poorer outcomes for women.
- Addressing metabolic syndrome, menopause-related risks, and female-specific factors is crucial for effective CVD prevention in women.
Abstract:
Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.
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