Shock news for women around the globe: your cardiovascular symptoms are not vaguely the equivalent of men’s and oughtn’t to be treated that way.
An expert panel organised by the Task Force on Gender of the European Society of Cardiology (ESC) highlights a gap in how women are diagnosed and treated and urges health care providers to consider female-specific health advice, instead of looking at women as a-man-but-a-bit-different.
“A woman’s life provides clues that you need to start early with prevention,” says first author Angela Maas, of Radboud University Medical Centre, the Netherlands. “We have to assess female patients differently to men, and not just ask about high cholesterol. This will enable us to classify middle-aged women as high-risk or lower risk for cardiovascular disease.”
The panel’s paper is a thorough report on ways health providers can advise women about cardiovascular disease issues related to menopause and hormones, sexual health, contraception, cross-sex therapy in transgender women, average socio-economic status and pregnancy complications.
In the paper, published in European Heart Journal, they say that many symptoms presented by women – such as hot flushes and palpitations – are misdiagnosed as menopausal causes, when in reality they are symptoms of hypertension.
“High blood pressure is called hypertension in men but in women it is often mistakenly labelled as ‘stress’ or ‘menopausal symptoms’,” says Maas, “We know that blood pressure is treated less well in women compared to men, putting them at risk for atrial fibrillation, heart failure and stroke – which could have been avoided.
“There are several phases of life when we can identify subgroups of high-risk women.”
Hypertension risk factors for women include pregnancy complications and early menopause. For example, pre-eclampsia – a potentially dangerous pregnancy complication characterised by high blood pressure – increases risk of heart failure and hypertension four-fold, and doubles the risk of stroke.
“High blood pressure during pregnancy is a warning sign that hypertension may develop when a woman enters menopause and it is associated with dementia many decades later,” says Maas.
Other autoimmune conditions, such as lupus and rheumatoid arthritis, are disproportionately high in women and also increase risk of cardiovascular disease.
“If blood pressure is not addressed when women are in their 40s or 50s, they will have problems in their 70s when hypertension is more difficult to treat.” says Maas.
The report provides advice on how to manage heart health during menopause, pregnancy and during conditions such as breast cancer and polycystic ovarian syndrome.
It provides advice for health experts on how to help all women, including transgender women.
“These women need hormone therapy for the rest of their lives and the risk of blood clots increases over time,” says Maas.
The report elaborates why transgender women “should always be encouraged to reduce modifiable lifestyle risks” while acknowledging that “the psychosocial benefits of hormone therapy with an improved body image may result in healthier lifestyle choices”.
Dr Deborah Devis is a science journalist at The Royal Institution of Australia.
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