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Clinical Articles, News & Views

Women at a greater risk for cardiovascular disease than men?

In conjunction with International Women’s Day (8 March 2013), the European Society of Cardiology (ESC) has released a statement reminding women that they may be at a greater risk for cardiovascular disease (CVD) than they think.

Although studies show a significant improvement in Europe’s heart health,1 the number of young women having heart attacks is on the rise, the ESC says.2 In fact, in an earlier statement released on World Heart Day (29 September 2012), it was announced that CVD is the main cause of death for women in each of the 27 EU countries.1

Professor Nicolas Danchin, France, ESC spokesperson, said: “In these instances, most of the women were smokers.” In fact, a 2010 survey3 in France showed that 73% of women under age 60 who had heart attacks smoked.

Nonetheless, most women don’t realise how common heart attacks and stroke are among their gender. CVD has typically been considered a condition that mostly plagues men. Although most heart attacks occur in women above 70 years old, recent French data4 confirms earlier reports that show a shift toward an increase in risk for heart attacks among middle-aged women.

In response, Professor Angela Maas, ESC spokesperson, said: “Many women mistakenly think that they are protected from heart disease by their oestrogen hormones.”

In addition to smoking, taking the birth control pill, obesity and a sedentary lifestyle are other ways that women increase their risk for CVD.

Regarding the pill, Professor Maas said: “The modern generation of oral contraceptives has lowered the increased risk for stroke compared to birth control pills available in the past.”

Professor Danchin added: “For women who take the pill and smoke, their risk for heart attack increases tremendously.”5

Traditional heart disease risk factors also play a role. These include dyslipidaemia, hypertension, diabetes and a family history of heart disease. In addition, female-specific risk factors also increase a woman’s chance for CVD. These include hypertensive pregnancy disorders, gestational diabetes, bleeding disorders related to menstruation, premature menopause, polycystic ovary syndrome, age of menopause and severity of menopausal symptoms.

According to Professor Maas: “80% of CVD can be avoided.6 Women can prevent heart disease by maintaining a healthy lifestyle throughout their entire lives, by exercising regularly, eating a healthy diet, avoiding stress, maintaining a normal weight and not smoking.” Women should be aware of their risk factors and report any pregnancy problems to their physician.

Professor Danchin advises having your cholesterol, blood sugar and blood pressure checked regularly, especially after menopause when the CVD risk in females rapidly increases. If your blood pressure exceeds 140/90, your chances are increased for heart disease.

Both men and women need to be aware of the signs and symptoms of a heart attack, which include pain in the middle of the chest, neck or left arm, or suddenly being out of breath. If you experience any of these symptoms, contact emergency help immediately.

Although CVD is the main cause of death in women, Professor Maas said: “There is a great lack of knowledge among cardiologists on the insights in gender differences in CVD that have been passed over for the last 20 years.”7 Women are less well diagnosed and are undertreated.

Professor Maas continued: “In the development of new medical therapies, female patients are still underrepresented. As cardiology has reached many technical developments, we need to focus more on female patients.” This includes more governmental support to encourage CVD research in women, greater public health efforts to increase awareness of CVD risk in women, development of educational programs on gender differences in CVD, greater gender-specific analysis in clinical trials and studies and increased enrollment of women in CVD studies.


1. European Cardiovascular Disease Statistics, 2012 edition. Authors, Melanie Nichols, Nick Townsend, Peter Scarborough and Mike Rayner, British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford, and Jose Leal and Ramon Luengo-Fernandez, Health Economics Research Centre, Department of Public Health, University of Oxford. This report can be downloaded from the ESC and EHN websites.

2. De Peretti C, Chin F, Tuppin P, Danchin N. Personnes hospitalisées pour infarctus du myocarde en France: tendances 2002-2008. BEH 2012;41:459–65.

3. Puymirat E, Simon T, Steg PG, et al. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 2012;308:998–1006.

4. Towfighi A, Zheng L, Ovbiagele B. Sex-specific trends in midlife coronary heart disease risk and prevalence. Arch Intern Med 2009;169:1762–6.

5. Farley, TM. Combined oral contraceptives, smoking, and cardiovascular risk. Epidemiol Community Health 1998;52:775–85. Available here<>. Accessed Feb. 10, 2013.

6.  Stampfer, MJ, et al. Primary Prevention of Coronary Heart Disease in Women

Through Diet and Lifestyle. NEJM 2000;343. No. 1.

7. Maas, A. Red Alert for Women’s Heart: The urgent need for more research and knowledge on cardiovascular disease in women. Euro Heart J. Advanced access published March 15, 2011.

Published on: March 27, 2013

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