IWD: Women, COVID and Heart Disease

Cardiovascular disease CVD is responsible for causing 35% of deaths in women each year. Yet, CVD in women remains understudied, under-recognized, under-diagnosed, and under-treated, with women under-represented in clinical trials. 

As per the Johns Hopkins Heart and vascular medicine research, “women present heart problems differently than men, and since heart disease is the leading cause of death in women, research on better diagnosis and treatment is vital.”

Cardiovascular disease is a very broad term. It also includes high blood pressure, valve disease, stroke, abnormal heart rhythms, and many other heart and blood vessel conditions. Better awareness will bring in a precautionary approach among women. But the problem seems to be deeper than that.

Pamela Ouyand, Director, Johns Hopkins Bayview Medical Center says, “The most important difference between treating men and women heart patients, is the greater difficulty in determining if a woman is at risk in the first place. Commonly used measures such as the Framingham Risk Score may not be as able to capture an accurate picture of risk in women. For instance, many women under 65 who present with a myocardial infarction, if assessed the day before the heart attack, would likely qualify as low risk because the traditional risk assessment scores do not take into account factors such as  stress and depression, presence of rheumatologic disease and presence of metabolic syndrome that may constitute a higher risk in women than in men.”

There is clearly an urgent need to study risk factors specific to women, such as pregnancy-associated diabetes and hypertension and elevated levels of testosterone before menopause. Specific research on conditions such as vascular stiffness, heart valve disease during pregnancy, heart attacks that occur without obstructed coronary arteries, and autoimmune diseases and how they specifically affect the hearts of women will help develop new preventions and treatments would be the key to understanding women and heart disease in the future.

Dr Devi Shetty, Chairman, Narayana Health has often said that nature will protect women till the age of 45-50 (till menopause). After that if they won’t take care of their heart they are susceptible to major coronary heart diseases.

The evolution of certain habits of women have also been harmful. Dr Devi Shetty adds, “A lot of heart problems can be reduced by changing the lifestyle like quitting smoking, chewing tobacco, obesity should be avoided and a physically active lifestyle followed”.

Lastly, in the current scenario, what is significant is that heart disease has been further exacerbated by COVID. 

Dr. Ramakanta Panda, worlds’ leading cardiac surgeon and head of Asian Heart Institute, Mumbai, adds perspective, “If you remove the 'O' and 'I', COVID becomes CVD. Covid- 19 has been like a stress test for the heart. The logic is simple: Covid is known to affect the lungs. The air we breathe contains oxygen and goes to our lungs. When the lungs don't do their job, the heart gets stressed and has to work harder. This increased demand for oxygen may cause heart rhythm disturbances; which in turn might lead to heart attack or heart failure." 

Many experts all over the world have also agreed that Covid unmasks silent cardiac symptoms among people with previously undiagnosed heart disease. A case in point being a  study from Mayo Clinic in 2021, which propounds that women face more symptoms of "post-COVID syndrome" and are frequently referred to as COVID "long haulers" rather than men. 

With women’s day around the bend,  we are clearly at a point in medical history where understanding heart disease in women deserves to be a study all its own.