Despite significant headway in the understanding of how cardiovascular disease differs between women and men, there is still a void in our diagnosis and treatment of women – both because women themselves do not present in a timely manner and because healthcare professionals do not think of women as being at risk. The fact is that more women will die of cardiovascular disease than all cancers combined. As our population ages, women continue to outlive men by a few years, but the risk of cardiovascular disease increases to the same level as men within 10 years of menopause.
Young women, especially those with underlying inflammatory disorders and diabetes, or previous high risk pregnancies (such as gestational diabetes, hypertension or eclampsia), are at significantly increased risk of cardiovascular disease and often do not present with classic symptoms. Our advanced imaging with cardiac PET is able to diagnose “microvascular” disease. This occurs more frequently in women, causes chest pain syndromes, and carries with it increased risk of symptoms and cardiovascular events. Women who have continued symptoms but “normal” coronary arteries by our conventional tests would benefit from an evaluation for microvascular disease.
In addition, shortness of breath is a very common complaint, especially as women age, and is frequently ignored. It is often caused by stiffening of the heart muscle (called diastolic dysfunction or “heart failure with preserved ejection fraction”), which then causes pressure and fluid to build up in the lungs. It is associated with hypertension and obesity, and can be treated with lifestyle modification, hypertension control and medications.