Women were always believed to be at lesser risk of heart conditions until recently. There was a misconception that they have the protection from the hormone estrogen. However, the protective effect of the hormone can be nullified by several other factors like genetics and lifestyle changes. Women can be at equal risk or sometimes at even higher risk of developing heart failure than men. There are differences in the causes of heart failure, treatments and the way women respond to the treatments.
During an interview with Happiest Health, Dr Aditi Singhvi, consultant, heart failure and transplantation medicine, Narayana Institute of Cardiac Sciences, Bangalore, spoke about these differences, which are not just due to biological factors but also due to inherent biases and cultural factors. The expert was present at Shakti Conclave 2.0, an event held in Bangalore to discuss heart health in women.
Heart failure in women
Dr Singhvi says traditional risk factors for heart diseases like hypertension, diabetes, smoking and obesity have more impact on women than on men. Due to these risk factors, a woman has a higher risk of developing heart failure than a man. “Apart from these risk factors, certain other factors are specific to women — gestational diabetes or pregnancy-induced hypertension, which is called gestational hypertension or pre-eclampsia. Women can also develop postpartum cardiomyopathy where the changes during pregnancy can cause heart failure,” she says. Women also tend to develop more inflammation due to autoimmune diseases like rheumatoid arthritis and experience a surge in catecholamines due to emotional stress, adding to the risk.
An existing family history adds to the risk of heart failure in women. “If a woman develops pregnancy-induced hypertension and also has a family history of heart failure, she would more likely develop it because of the issues that happen in women’s lives that men don’t experience,” she adds.
Why does it affect women differently?
Dr Singhvi says differences in the hormones, estrogen and androgen, play a significant role. “Women have a higher immune response in cases of injury, which also plays a role in the pathophysiology of heart failure. The blood and muscle volume are less in women than in men. Women also have a higher percentage of body fat than men. All these factors play an important role in how drugs are metabolized and how a woman responds to medications that are used to treat heart failure,” she adds.
Managing heart failure in women
Dr Singhvi says women are more symptomatic than men. Though dietary changes and exercise recommendations are the same for both men and women, she adds that women may need more than 150 minutes of moderate to intense workouts in a week as they tend to have lower exercise tolerance than men.
Women are more susceptible to the adverse effects of alcohol as well. “The advisable limit is 2 units daily for a healthy man, compared to one for a healthy woman without heart failure. If one is diagnosed with heart failure, alcohol is not recommended,” she says. She also adds that a woman with this condition might need a change in medications if she is planning for a pregnancy and should consult a cardiologist and an obstetrician — who deals with high-risk pregnancies — before conceiving, to understand if it is safe for her to get pregnant.
There are several challenges in treating women with heart failure. “All treatments used to treat heart failures are extensively and scientifically studied. However, since women are underrepresented in clinical trials, we are uncertain if both men and women respond to treatments similarly. Certain women respond better to certain medicines than men, while others respond poorly. Hence, there needs to be some difference in how we prescribe these medications or treatments, which needs further study,” says Dr Singhvi.
Additionally, women are less frequently referred to device implantations and advanced therapies like heart transplants due to inherent biases and cultural factors, she adds.
Takeaways
- Women can be at higher risk of having heart failure when compared to men, due to several factors including diabetes, obesity, and hypertension.
- The differences in the hormones play a significant role in women.
- Women may need more than 150 minutes of moderate to intense workouts in a week as they tend to have lower exercise tolerance than men, say experts.
- Further studies with better representation of women should be conducted to understand the differences better, say experts.
