Cardiovascular ( CV) diseases are the leading cause of death among women, responsible for 35% of all female deaths globally, according to 2019 data. Alarmingly, myocardial infarction cases are rising among younger women. To address this, the Spanish Society of Cardiology’s (SEC’s) Working Group on Women and Cardiovascular Disease (SEC-GT CVD in Women) and the Association of Preventive Cardiology convened a multidisciplinary panel of experts from various Spanish societies and associations.

Representatives from gynaecology, endocrinology, paediatrics, primary care, family medicine, and midwifery collaborated to create a consensus document. This clinical guideline, approved by the SEC and published in the English edition of Revista Española de Cardiología, aims to assist healthcare professionals in diagnosing and managing women’s CV health, focusing on gender-specific differences.

Disease Prevention

Early detection of CV risk factors in women is critical. “This guide aims to raise awareness among healthcare professionals about the importance of preventing CVD in women, highlight the differences between men and women, and provide specific preventive recommendations tailored to the different stages of a woman’s life,” Dr Antonia Sambola, coordinator of SEC-GT CVD in Women and researcher at the Department of Cardiology, Vall d’Hebron University Hospital and Research Institute in Barcelona, Spain, told Univadis Spain, a Medscape Network platform.

However, Sambola stressed the importance of implementation: “A clinical guide that is not implemented is just paper. It is vital that this guide is implemented in clinical practice. For this reason, the SEC will undertake several initiatives to disseminate it, including meetings with representatives from the Ministry of Health to ensure it is distributed to the autonomous communities.”

Age-Specific Risks

The guidelines highlight age-specific CV risks for women.

• In adolescent girls (10-21 years of age), key risk factors include a higher fat-to-lean mass ratio than that in boys (25% vs 14%), reduced physical activity, and higher smoking rates.
• In women aged over 21 years, conditions such as polycystic ovary syndrome (PCOS), hypogonadotropic hypogonadism, and premature ovarian insufficiency (POI), all characterised by oestrogen deficiency, significantly increase CV risk. These hormonal imbalances are linked to metabolic disorders such as insulin resistance, central obesity, dyslipidaemia, and hypertension.
• Menopause is associated with oestrogen production, leading to metabolic changes, including central abdominal fat accumulation, obesity, sarcopenia, and dyslipidaemia, which increase the risk for myocardial infarction and cerebrovascular events.

Hormone replacement therapy (HRT) is recommended for premenopausal women with POI or hypogonadotropic hypogonadism if there are no contraindications. Transdermal oestrogens have a more favourable impact on CV risk biomarkers than oral formulations.

Menopause is associated with reduced CV protection due to decreased oestrogen production. Metabolic changes during this phase, including central abdominal fat accumulation, obesity, sarcopenia, and dyslipidaemia, increase the risk for myocardial infarction and cerebrovascular events, particularly in cases of early menopause.

Recent studies have found HRT to be the most effective intervention for symptom relief and improved quality of life. These measures can reduce CVD risk and all-cause mortality in women aged under 60 years and within 10 years of menopause onset. However, HRT is not recommended for patients with high CV risk or pre-existing CVD.

Pregnancy Risks

Pregnancy causes significant CV changes, necessitating close monitoring. In women with pre-existing cardiometabolic risk factors or genetic or environmental predispositions, the physiological stress of pregnancy can lead to adverse outcomes, such as hypertensive disorders, intrauterine growth restriction, small-for-gestational-age neonates, placental abruption, preterm birth, and gestational diabetes mellitus (GDM). Women with a history of adverse pregnancy outcomes have a higher long-term risk for CVD.

Pre-pregnancy evaluations and early detection during weeks 11-13 of pregnancy are critical for identifying CV risks. Hypertensive disorders affect 10% of pregnant women, and GDM is another significant risk factor.

Additional Risks

Classic CV risk factors in women include smoking, obesity, hypertension, diabetes, and dyslipidaemia. Additional factors included:

• Breast cancer survivors face higher risks for heart failure and myocardial ischaemia due to latent cardiac effects from cancer treatments.
• Psychosocial stress: Strongly associated with the development and progression of CV atherosclerosis.
• Autoimmune diseases: Conditions such as systemic lupus erythematosus and rheumatoid arthritis significantly increase the risk for CV disease.

Gender-Specific Challenges

“Being a woman is itself a risk factor for CVD,” explained Sambola. She highlighted three key issues: Inadequate medical training in gender-specific disease management, lack of routine screenings for women-specific CV risks, and widespread public misconceptions about CVD being less fatal than breast cancer.

Public awareness campaigns are essential to address these gaps. These should focus on age-specific CV self-care measures, such as quitting smoking and alcohol, engaging in physical activity, and routine health checks for glucose, blood pressure, and body weight.

“Finally, all women with early menopause, POI, and PCOS should undergo routine CV screenings,” concluded Sambola.

This story was translated from Univadis Spain using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.