If you are still among those who underestimate the risk of heart attack and stroke in women, convinced that female hormones protect like an umbrella for life, you really need to change your opinion. It is early. After menopause, in the presence of coronary arteries with lesions from atherosclerosis and consequent obstruction of the vessels, the probability of having a heart attack in women would be even greater than in male peers.
Once again, the presumed cardiovascular protection for the female population is eliminated, at least after the end of fertile life, by a research presented at the EACVI 2023 Congress of the European Society of Cardiology (ESC), published in European Heart Journal – Cardiovascular Imaging. The study, coordinated by Sophie van Rosendael from Leiden University, is particularly interesting because it correlated cardiovascular outcomes such as heart attacks and deaths with arterial occlusion status, as assessed by computed tomography angiography.
Atherosclerosis comes later in women
In women, atherosclerosis develops later. But according to the results of the survey, which will need to be confirmed, after menopause the presence of plaques becomes much more difficult to manage in women. The research examined 24,950 patients undergoing coronary computed tomography angiography (CCTA) which allows for three-dimensional images of the heart arteries, enrolled in the CONFIRM registry.
To evaluate the “weight” of theatherosclerosis a parameter called total atherosclerotic burden was used. On the basis of this evaluation, the subjects studied were divided into three groups, respectively with low, medium and high atherosclerotic load.
Coronary pathologies were defined as obstructive with a narrowing of the vessel caliber of 50% or more. The subjects considered, 11,678 women (mean age 58.5 years) and 13,272 men (mean age 55.6 years) were followed up for 3.7 years. First data to emerge: coronary artery atherosclerosis in women arises about 12 years later compared to men. But the danger should not be underestimated even in the absence of significant obstructions. According to the author of the research “women are more likely to have non-obstructive diseases. In the past it was thought that only obstructive atherosclerosis caused myocardial infarction, but now we know that non-obstructive disease is also risky”.
What happens after menopause
The weight of atherosclerosis was equally predictive of cardiovascular events (the so-called MACE extension – major cardiovascular events, such as death from all causes, myocardial infarction, stroke and need for coronary revascularization treatments within 30 days) in women under 55 years of age compared to their peers.
But in later ages the overtaking of women is clear, with a much higher risk of MACE than men, especially in the presence of major injuries. In postmenopausal women, compared with those with low load, those with medium and high load had a 2.21-fold and 6.11-fold higher risk of MACE.
While in men 55 years of age and older, compared with those with a low load, those with a medium and high load had 1.57-fold and 2.25-fold greater risks of MACE. “In this study, the higher risk for women than men was particularly observed in postmenopausal women with the highest CCTA score,” she said. This may be partly because the internal diameter of the coronary arteries it’s smaller in women, meaning that the same amount of plaque could have a greater impact on blood flow.”
But that’s not all: the survey results confirm that there is a rapid acceleration of the development of atherosclerosis after menopause with a significantly increased relative risk for women compared to men, despite a similar burden of atherosclerotic disease.
Plaque is different in women
Even if the situation for women is often underestimated, protecting the heart and blood vessels appears to be essential. Which means keeping risk factors under control, from hypertension to smoking and being overweight, obviously passing through the increase in LDL cholesterol, the real “fuel” for the development of atherosclerotic plaque. We always remember that it is not only the volume of the coronary atheroma, but also the composition of the plaque itself that varies between men and women and is much more vulnerable in pre-menopausal women – let us know Francis VersaceDirector of Cardiology at the Santa Maria Goretti Hospital in Latina.
Not only. In recent studies published in “Circulation” carried out on the plaques responsible for infarction with optical coherence tomography (a sort of electron microscope to define the details of plaques and vessel walls), women who develop an acute myocardial infarction in post-menopause have vulnerable plaque characteristics already present in childbearing age such as: increased lipid concentration, thin capped plaque, increased concentration of macrophages, cholesterol crystals and calcifications”.
In short, targeted prevention is needed. Knowing your risk profile is essential, especially for those who have had another case of heart attack in the family, which means setting aside time for regular physical activity and keeping factors such as hypertension, blood sugar, smoking and being overweight under control , obviously passing through the increase in LDL cholesterol, the real “fuel” for the development of atherosclerotic plaque.
Second Sophie van Rosendael “The results indicate that after menopause, women may need to take a higher dose of statins or add another lipid-lowering drug.”
“The investment in health must be made early as early and “aggressive” antidyslipidemia therapy with the new PCSK9 inhibitors can “freeze” plaques at risk of rupture and even make them decrease in volume and vulnerability components – confirms Versaci “.
