2023-09-04 10:37:25
Cardiovascular disease (CVD) is the leading cause of death in the worldwith nearly 19 million deaths per year, about one third of all deaths worldwide.
Traditionally, CVD is thought to be a problem for middle-aged men with hypertension and obesity, in whom atherosclerotic plaques begin to develop, grow to clog blood vessels, and eventually rupture and cause a cardiovascular event.
However, cardiovascular disease does not only affect men. Women also develop atherosclerotic plaques, but there are gender differences in atherogenesis, the process of plaque formation. Experts discussed gender differences in cardiovascular disease risk factors in a session of the Congress of the European Society of Cardiology in Amsterdam.
One of the main differences is that men are about 10 years ahead of women in the formation of atherosclerotic plaques. On average, they have more plaques at any age than women, as shown by carotid artery ultrasound, and experience myocardial infarctions and other cardiovascular events at younger ages.
Non-traditional risk factorssuch as pregnancy complications, psychosocial stress, low estrogen, breast cancer, autoimmune diseases and depression, contribute to the development of cardiovascular disease in women.
Lina Badimon, from the University of Barcelona, noted that overall age-adjusted cardiovascular mortality has generally declined over the past few decades. However, this decrease is less in women than in men. Cardiovascular mortality rates, on the other hand, continue to increase among women under 55 years of age.
Another observation, the proportion young men hospitalized with acute coronary syndrome increased from 30% to 33% between 1995 and 2014, while that of young women increased from 21% to 31% during the same period.
“The risk in young women is also high and should not be overlooked,” said the Dr Bodimon. “And the idea that the risk [de MCV] in women increases only after menopause should be reviewed.”
Dyslipidemia
Sex differences in lipid metabolism appear from the earliest stages of life.
A recent study showed that female newborns show higher concentrations of many metabolites of cholesterol and polyunsaturated fatty acids and lower concentrations of monounsaturated fatty acids than male newborns, but the clinical relevance of this phenomenon is not yet clear.
In men, the level of low-density lipoprotein cholesterol (LDL-C) rises sharply by 64% between the ages of 20 and 49, while in women it remains unchanged until around the age of 35. after which it increases sharply by 42%with the largest increase occurring after the menopause.
The average total cholesterol level peaks about 10 years earlier in men, between the ages of 40 and 49, but in women, the cholesterol peak is higher.
Women with polycystic ovary syndromethe most common endocrine disorder in women of childbearing age, present a significant increase in triglyceride and LDL-c levels.
The lipid profile of women also changes during of the menstrual cyclelipoprotein cholesterol levels varying as a function of endogenous and exogenous estrogens.
Pendant the pregnancy, LDL-c levels increase by 40 to 60 percent, and triglyceride levels increase two to three times. This phenomenon is particularly important in women with familial hypercholesterolemia (FH), as it results in a very high absolute increase during a period associated with significant treatment gaps.
“We need to pay particular attention to women with familial hypercholesterolemia, due to the higher cholesterol burden in younger people, especially during pregnancy, which is aggravated by periods of treatment interruption,” said Ulrich Laufs, professor of cardiology at the University of Leipzig.
This is emphasized a new call to action from the European Atherosclerosis Societywho recommends “take measures to minimize the periods of interruption of statin treatment in women with FH after pregnancy and lactation”.
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