Myocardial infarction in women: a lesser known disease

Un myocardial infarction It can manifest itself with different symptoms that include pain or pressure in the chest, a feeling of general malaise, fatigue, dizziness, nausea, sweating or shortness of breath, among others. The affected person could experience a multitude or just a couple of these symptoms, with mild or strong intensity, resulting in various manifestations of the disease. Some of these manifestations may be less characteristic and, as a consequence, more difficult to recognize by patients or healthcare personnel. Scientific evidence shows that women are more likely to experience less characteristic combinations of symptoms, and that this influences the diagnostic process and the consequences of the disease.

El acute coronary syndrome It is the term that groups together the various conditions characterized by the obstruction of the coronary arteries and that gives rise to what the population knows as 'heart infarction'. It is one of the main causes of mortality, morbidity and healthcare costs in Spain. According to the National Institute of Statistics, ischemic heart diseases caused more than 29.000 deaths in our country, 38% of these in women. Mortality from this type of disease has decreased significantly in recent decades, although to a lesser extent in women than in men.

Chest pain or chest pressure is the most common symptom of a coronary syndrome, occurring in more than 80% of cases in both sexes. However, studies show that women are less likely to experience it than men. They are more likely to suffer from other, more diverse symptoms unrelated to chest pain, such as pain between the shoulders, nausea, vomiting, or difficulty breathing, and are more likely to attribute these symptoms to other conditions not related to the heart, such as gastroesophageal reflux, stress or anxiety. These symptoms in women should not be underestimated. Partly because of these misattributions, women tend to wait longer to seek medical care. This can have a negative impact on your prognosis, because delays in receiving treatment decrease the chance of survival and increase the risk of complications.

Compared with men who have coronary syndrome, women tend to be older, have more comorbidities, and are less likely to receive treatment, as established in the clinical guidelines. All of these factors contribute to the prognosis of coronary syndrome being worse in women than in men.

There are also sex differences in the prevalence of cardiovascular risk factors such as smoking, high blood pressure, diabetes, cholesterol, obesity or a sedentary lifestyle. There are certain biological factors related to coronary anatomy and function that are specific to women. and there are strictly female cardiovascular risk factors such as menopause, preeclampsia, gestational diabetes or premature birth. All of these differences and the mechanisms that generate them form an active field of study that seeks to understand and improve cardiovascular outcomes in women.

The best strategy in the fight against coronary syndromes, for both men and women, remains prevention: not smoking, doing regular physical activity, maintaining a healthy weight and following a healthy diet are some of the most important advice from the Spanish Society of Cardiology.

To reduce the prevalence and impact of cardiovascular diseases in women, we must continue promoting awareness, education and prevention. On the other hand, gender equality in medical care and the promotion of a comprehensive approach are other fundamental aspects. Much remains to be done to offer equitable cardiovascular care to women, because cardiovascular diseases continue to be perceived, both by society and by medicine, as men's diseases.

Maria José Sánchez Pérez. Scientific Director of ibs.GRANADA