Gender Differences in CVD

Question 1

Are men or women more likely to die of cardiovascular disease?

Answer 1

Woman are more likely to die of CVD

Question 2

Describe some of the reasons for the lack of understanding of the differences about CVD in women

Answer 2

In trials women are underrepresented

Evidence based medicine is biased towards men

Publication bias

False assumption and lack of awareness amongst women and healthcare providers

Question 3

Describe the gender differences in heart failure

Answer 3

Women are more likely to get preserved ejection heart failure

Question 4

Describe the gender differences in hypertension

Answer 4

More common in older women then older men

Woman more likely to get left ventricular hypertrophy, it is also less likely to regress in women

Question 5

Describe the gender differences in stroke

Answer 5

Worse outcomes

Woman live longer –> more strokes

Question 6

Describe the gender differences in atrial fibrillation

Answer 6

Women have a greater risk of stroke due to AF

Question 7

Describe the gender differences in aortic aneurysm

Answer 7

Less common is women

Complications and outcomes are worse in women

Question 8

Describe the gender differences in acute MI

Answer 8

women are more likely to have complications during recovery:

• Cardiogenic shock
• Heart failure
• Re-infarction

Question 9

List general reasons for why women have worse CVD outcomes than men

Answer 9

Atypical presentation –> delayed diagnosis

Lack of risk, and symptom awareness in woman

More comorbidities

Gender assessment bias

Biological differences (drug response, blood vessel size)

Greater procedural complication rate

Question 10

Describe the gender assessment bias seen in the treatment of CVD

Answer 10

Women undergo tests generally later than men (with the same presentation) do

Question 11

Describe the different features of coronary artery disease (CAD) in women

Answer 11

Smaller vessels = bad

More diffuse disease

More plaque erosion, embolisation

Increases fibrosis and remodeling

Less obstructive CAD than in men

Question 12

Describe the risk of ischaemic heart disease pre, during, and post menopause

Answer 12

Premenopause:
- Low risk

During:
- low/medium risk

Post menopausal:
- High risk

Question 13

Describe the distribution of atherosclerotic plaques in CAD in woman vs men

Answer 13

Women:
- More diffuse plaques

Men:
- Plaques are more concentrated

Question 14

List heart attack symptoms that are only typical seen in women

Answer 14

Milder symptoms (without chest pain)

SoB

Sudden weakness, fatigue, aches, or overall feeling of illness (without chest pain)

Unusual feeling or mild discomfort in the back, chest, arm, neck, or jaw (without chest pain)

Heartburn, nausea, vomiting, abdominal pain

Symptoms may occur up to a month before MI: fatigue, sleep disturbance, SOB, anxiety, indigestion, palpitations

Question 15

List female specific CVD risk factors

Answer 15

• Hypertension during pregnancy
• Early menopause
• Gestational diabetes

Question 16

Describe the different significance of diabetes as a CVD risk factor between genders

Answer 16

In women diabetes creates a higher risk than in men