Women’s heart health: Risk, prevention, and management

Women’s heart health: Risk, prevention, and management | Image Credit: © Syda Productions - © Syda Productions - stock.adobe.com.

Women face unique cardiovascular risk factors compared to men, such as reproductive health factors and early menopause.¹ However, detection and treatment options are available to ensure women with breast cancer live full, healthy lives.

The risks of adverse cardiovascular outcomes in women were recently highlighted by Martha Gulati, MD, professor of cardiology at Cedars Sinai, in an interview with Contemporary OB/GYN. Both women and men face common risk factors such as diabetes and smoking, but Gulati noted a greater risk from diabetes in women compared to men.¹

While both men and women face an increased risk of cardiovascular disease from smoking, the vascular damage is increased in women vs men for the same number of cigarettes smoked. Additionally, women face sex-specific risk factors for cardiovascular health.¹

Women-specific factors linked to cardiovascular health include age at menarche, age at first period, early menopause, and premature ovarian failure. Additionally, conditions that occur during pregnancy such as preeclampsia, gestational diabetes, and preterm birth further increase the risk of cardiovascular disease.¹

The impact of pregnancy-related disorders on cardiovascular disease in menopausal women was evaluated in a study conducted by Marie Tan, a fourth-year medical student at Drexel University College of Medicine.² The study, presented at the 2024 Annual Meeting of the Menopause Society, was made to address the lack of data about this topic.

Data was obtained from a larger investigation known as the Breast Arterial Calcification Study. Three hundred and eighty women aged a mean 81.6 years, most of whom resided in Connecticut, were included in the analysis. While many participants were lost to death or lack of follow-up, the 20% retention rate allowed for a detailed analysis.²

Alongside preeclampsia and gestational diabetes, the impact of gestational hypertension on cardiovascular disease risk was evaluated. A significant association was reported for gestational hypertension, but not preeclampsia or gestational diabetes, with cardiovascular disease.²

Tan was surprised by these outcomes because prior studies reported preeclampsia as the primary predictor of cardiovascular disease. These findings highlighted the importance of understanding how women’s health may be impacted in aging women from pregnancy-related conditions they experienced decades prior.²

“Women make up 50% of the population in the world, and women and men are getting older, so there will be a lot more new patients who are a lot older,” said Tan. “So, I think it’s really important to even go all the way back to pregnancy for menopausal and postmenopausal women and really take the time to consider different risk factors that are related to pregnancy.”²

A paucity remains in research, indicating a need to obtain more data about this topic. However, this gap was partially filled by a recent study evaluating the connection between breast arterial calcification (BAC) seen on mammograms and cardiovascular outcomes including cardiovascular disease and mortality.³

The study was conducted by Lori Daniels, MD, FACC, professor of cardiovascular medicine at UC San Diego. According to Daniels, women with calcium in the arteries of their breast may have increased risks of future cardiovascular events. These include heart failure, heart attack, stroke, and even all-cause mortality.³

While BAC can be identified on routine mammograms, it was only recently that experts began to consider this characteristic as a predictor of future cardiovascular outcomes. The recent study included over 18,000 women’s mammograms, with follow-up lasting for up to 11 years. BAC quantity was identified using automated technology.³

During the follow-up period, investigators measured rates of heart attacks, strokes, heart failure, and all-cause mortality among participants. Those presenting with BAC, especially in high amounts, were significantly more likely to experience adverse cardiovascular outcomes.³

These results remained when adjust for characteristics that influence heart health, such as smoking, age, high blood pressure, and high cholesterol. This indicates a need to consider BAC for future risk assessment.³

According to Natalie Bello, MD, MPH, FACC, cardiovascular disease is the primary cause of death in both men and women, but there are many women who do not view heart disease as a significant health concern.⁴ Additionally, the number of women perceiving heart disease as the leading cause of death decreased from 2009 to 2019.

Bello expressed concern over the declining rates of awareness among Hispanic and non-Hispanic Black women, who face increased risks of heart disease. Women aged 25 to 34 years who are key targets in primary prevention or primordial prevention are also often unaware about the risks of heart disease.⁴

Approximately 80% of cardiovascular disease cases are preventable when risk factors are detected and treated, highlighting the importance of spreading awareness about heart health. Bello recommended large scale public health campaigns to increase knowledge about cardiovascular disease, which kills more patients than all other cancers per year.⁴

According to Gulati, collaboration between cardiologists and ob-gyns is vital for managing heart health in women.¹ Many women consider their ob-gyns to be their primary care, and by being aware of this fact, cardiologists can improve collaboration with their obstetrician and gynecologist colleagues.

“Nowadays I’d say we intersect so closely because we’re all trying to improve the health of the woman that we care for,” said Gulati. “I think the biggest thing that obstetricians and gynecologists can do, which I think a lot of them are doing, is helping them get screened for cardiovascular disease.”¹

These screening measures include checking patients’ blood pressure, measuring cholesterol, and noting the female-specific risk factors these patients might carry. While gynecologists aren’t expected to treat these conditions, they can help patients reach cardiologists for care through these methods.¹

This collaboration has been highlighted in cardio-obstetric clinics, which are partnerships between obstetricians and cardiologists. In these clinics, which have become more common over time, women with adverse pregnancy outcomes may be identified to assess for cardiovascular risks.¹

These assessments may occur through a single assessment or lifetime assessments based on the patient. Through them, women are made more aware of the long-term risks associated with pregnancy-related conditions, letting them adapt preventative behaviors that may save their lives.¹

According to Daniels, cardiovascular risk prevention may be influenced by the new data about BAC on mammograms.³ An important finding in the data was the presence of BAC especially in younger women.

Older women are more likely to know they are at an increased risk, but BAC may be the first risk factor identified in younger patients. This provides these women with the opportunity to take preventative measures such as diet and exercising to reduce their risk of cardiovascular disease.³

While it often takes a while to effectively bring a risk factor into clinical use, Daniels believes BAC is a relatively finding to bring into practice. The data is already available, and women will often begin to receive annual mammograms when aged 40 years, making no additional screening required to incorporate BAC into cardiovascular risk assessment.³

Bello noted that there are many resources available to help prevent heart disease in women.⁴ The American Heart Association's life's essential aid provides an overview of key measures linked to heart health, and blood pressure is the primary risk factor that may be observed during pregnancy.

“For individuals who have had high blood pressure during their pregnancy, it's really important to remember that that was your risk factor,” said Bello. “Tell all your other clinicians that you've had that risk factor and get your blood pressure checked regularly in addition to other things like your cholesterol and making sure you don't have diabetes.”⁴

References

1. Krewson C. Understanding cardiovascular risk factors in women. Contemporary OB/GYN. October 28, 2024. Accessed November 1, 2024. https://www.contemporaryobgyn.net/view/understanding-cardiovascular-risk-factors-in-women
2. Krewson C, Fitch J. Pregnancy disorders linked to cardiovascular disease in menopausal women. Contemporary OB/GYN. September 16, 2024. Accessed November 1, 2024. https://www.contemporaryobgyn.net/view/pregnancy-disorders-linked-to-cardiovascular-disease-in-menopausal-women
3. Krewson C. Mammograms may reveal hidden cardiovascular risks, study finds. Contemporary OB/GYN. October 16, 2024. Accessed November 1, 2024. https://www.contemporaryobgyn.net/view/mammograms-may-reveal-hidden-cardiovascular-risks-study-finds
4. Krewosn C. Exploring the intersection of heart health and women's health. Contemporary OB/GYN. February 12, 2024. Accessed November 1, 2024. https://www.contemporaryobgyn.net/view/exploring-the-intersection-of-heart-health-and-women-s-health