Coronary artery disease (CAD) remains unrecognized, particularly inyoung women. In the modern era, women are self -dependent and are well aware of their rights, but unfortunately their awareness and attitude towards their health especially cardiovascular diseases is largely ignored. Women have eight times higher risk of dying from heart disease than from breast cancer, yet they fear more of breast cancer and neglect symptoms of heart disease .
CAD remains a major formidable health problem in women. Indeed, it is rightly said that coronary heart disease (CHD), the most prevalent form of heart disease, is “underdiagnosed, undertreated, and under researched” in women. Various studies on CAD in young patients labelled them as having “premature” CAD, but it is now better understood as a rapidly progressive form of the disease. According to the literature, most patients were males, but with changing scenario of CAD especially in females, the statement requires validation.
CAD occurring below the age of 45 years is termed as “young CAD.”However, various studies considered the age limit varying from 35 to 55 years in the spectrum of young. Regardless of race or ethnicity, CAD is the leading cause of death in women. The worldwide INTERHEART study, a large cohort study of more than 52,000 individuals with myocardial infarction (MI), revealed that the first presentation of CHD in women is approximately 10 years later than men, most commonly after menopause. Even though there is this delay in onset, mortality from CHD is progressing more rapidly among women than men.Diabetes and hyperlipidaemia are also frequently present in young CAD patients. Young women with CAD comprise an especially interesting group even though there is the protective effect of oestrogen, but predictive factors in this distinctly unusual cohort is poorly understood.
According to previous studies, hypertension and lack of exercise are both firmly established risk factors for CAD, but they appear to contribute only marginally in young adults. In young males, smoking is considered as a strong risk factor for CAD. According to the Framingham study, repeated exposure to cigarettes and the resulting frequent catecholamine surges damage endothelial cells, leading to dysfunction and injury to the vascular intima. Smoking is becoming a contributory risk factor in females although metabolic factors play an important role in female CAD. Women who smoke have a quantitatively similar risk as men but more than five times the risk of non-smoking women. Smoking in combination with oral contraceptives poses a 13-fold increase in CAD mortality.
Truncal obesity and increased body mass index (BMI) have been proposed as potential independent risk factors, particularly in young women with CAD. Sagittal abdominal diameter to skin fold ratio seems to be a good indicator in predicting premature CAD, even better than BMI and waist circumference.
Mortality after an acute coronary event is two times higher in women than in men aged less than 50 years. The cause of increased incidence of adverse event in women with premature CAD is still unknown. Many previous studies have shown that the females who presented with Acute Coronary Syndromes had complex coronary lesions than young males. However, the success and complication rates of Percutaneous Coronary Interventions are the same in both the groups.
By creating awareness about the modifiable risk factors, it can create an impact on the future of cardiovascular disease in women. Conventional and female-specific risk factors, novel biomarkers, and genetic analysis should be evaluated for better patient outcome and prognosis.
On this World Heart Day let’s be empowered to spread awareness worldwide to help achieve Cardiovascular health globally for every Heart with the Theme: “USE HEART FOR EVERY HEART”