Unique aspects and manifestations of cardiovascular disease in women

Cardiovascular disease (CVD) is the main cause of premature death in Canadian women. Several sex-specific differences in CVD symptoms and pathophysiology exist. To outline these differences, the Canadian Women’s Heart Health Alliance (CWHHA) Atlas on the epidemiology, diagnosis and management of CVD in women has released a new chapter that examines current and evolving knowledge about sex- and gender-unique manifestations of CVD in women. Read: Coffee may not trigger atrial fibrillation episodes: study The differences in CVD manifestations in men and women relate to symptom presentation and underlying pathophysiology, and how clinical outcomes are affected. These differences must be understood when evaluating women to determine optimal CVD management and improve patient outcomes.1 The key concepts in the new chapter of the Atlas are summarized below: Ischemic heart disease (IHD)—Symptoms of IHD vary between sexes. In addition, there are sex- and age-related differences in symptom presentation, pathophysiology and outcomes. Nonobstructive atherosclerotic mechanisms, including coronary microvascular dysfunction, vasospasm and spontaneous coronary dissection are under-recognized causes of angina and myocardial infarction in women. Obstructive and nonobstructive coronary artery disease—Obstructive coronary artery disease most often affects postmenopausal women, who often have a higher cardiovascular risk burden than men. Detecting atherosclerosis, even in the absence of obstructive lesions, is important in order to improve risk stratification and treatment of IHD in women. Heart failure—Women comprise up to 40% of those with heart failure with reduced ejection fraction (HFrEF). These women often have a high burden of comorbidities. Women with HFrEF have better survival compared to men, but a higher prevalence of depression, stroke and reduced quality of life. Heart failure in women more commonly manifests as heart failure with preserved ejection fraction (HFpEF). Valvular heart disease—Sex-specific pathophysiology in valvular heart disease is mostly unknown despite emerging evidence for distinct characteristics of valve lesions and therapies in women. Cardiomyopathies—Women are much more likely than men to develop stress cardiomyopathy (Takotsubo cardiomyopathy). Women may be more susceptible to autoimmune myocarditis and restrictive cardiomyopathies. Peripartum cardiomyopathy exclusively affects women, with differences in characteristics according to ethnicity. Arrhythmia—Sex differences in the clinical manifestations of arrhythmia are associated with normal cyclical hormonal changes in women. Vascular arterial disease—Women are at increased risk of complications when diagnosed with aortic aneurysmal and peripheral arterial disease. Stroke and vascular cognitive impairment—Women have unique risk factors that make them vulnerable to stroke across the lifespan, particularly during pregnancy and postmenopausal aging. Stroke can lead to vascular cognitive impairment later in life.1 Chapter 5 in the Atlas also contains several useful figures, including: Age-standardized prevalence/occurrence of major cardiovascular diseases (IHD, acute myocardial infarction, heart failure, stroke, dementia) in men versus women in Canada Age-standardized mortality rates for major cardiovascular diseases in Canada in men versus women Comparison of symptoms commonly reported by women versus men presenting with IHD. Consult the full chapter for more detailed information on the differences in CVD manifestations between men and women.1 Read: New CCS dyslipidemia guidelines push for Lp(a) testing The authors conclude that with a few notable exceptions, women-specific CVD data are insufficient to guide CVD management and guideline development. Greater efforts must be made to increase enrollment of women into clinical trials, in order to build a solid evidence-base for guideline-directed management.1 The first four chapter of the Atlas were released earlier and are available online. In addition to the newly released chapter 5 (discussed above), four additional chapters are expected soon.2 References 1. Pacheco C, Mullen KA, Coutinho T, et al. The Canadian Women’s Heart Health Alliance atlas on the epidemiology, diagnosis, and management of cardiovascular disease in women – Chapter 5: Sex- and Gender-unique manifestations of cardiovascular disease. CJC Open 2021; Published online November 22, 2021.(accessed November 29, 2021). 2. Canadian Women’s Heart Health Centre. CWHHA Atlas. (accessed November 29, 2021).

Unique aspects and manifestations of cardiovascular disease in women

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