Men are from Mars, women are from Venus. It may not be a fiction.afterall .It runs deep into q-bits and quark particles of our cells. The well known double X cross chromosome, epigenetics , along with hormonal interactions with cellular components make many of diseases more female centric.
Most importantly, women who are carrying a baby , are technically a chimera, and the two-way traffic of genetic materials across the placenta has unexplainable Immune interactions, making autoimmunity almost exclusively a female disorder (SLE, etc.).
Following is the partial list of women-centric heart disease
- Rheumatic Heart disease: RHD is common in both genders, but it attacks the mitral valve with a strikingly different rate in females, with a ratio of up to 4:1. This difference, however, wanes with aortic valve involvement.
- Mitral valve prolapse: More common in women, overriding the the fact, there are more tall men , who are likely to have more MVPS
- Takotsubo (stress) cardiomyopathy: 80-90% casesoccur in women. This is surprising. (Women are known to be great fighters of stress, in all walks of life; they outlive men by 5-10 years in terms of longevity. Still, when it comes to the heart, they seem to be sensitive.)
- NSTEMI vs STEMI in women (It is rather women are somewhat resistant to STEMI )
- Sponatneous coronary artery dissection has well known female domnace especailluy in duiring pregnancy (estrogenic vascular elastin fracture , striae gravidourm ?)
- Coronary microvascular disease: Higher prevalence in women; female rate up to 66%
- Peripartum cardiomyopathy: Exclusive to women by definition, incidence 1 in 5000 live births
- Heart failure with preserved ejection fraction (HFpEF): Women represent about 55-60% of cases. Odds are higher for sure. (Is that obesity ?)
- Primary pulmonary hypertension (Pre -capillary , again hormonal-endothelial interaction ?)
- Takayasu arteritis (aorto-arteritis): Strikingly high. Female to male ratio approximately 7:1
- Mitral annular calcification: Female to male ratio roughly 2:1; more severe in women, especially elderly (Aortic annulus , males dominate )
- In congenital heart disease Atrial septal defect has a female to male ratio approximately 2:1 (To remind TGA is strikingly a male disease)
Missing entities , may be added by readers
Final message
Knowing the gender difference in heart disease may not matter much, if we look at things superficially. Decades down the line, It has a huge potential in preventive cardiology, as the current genome-level interventions and female-specific vaccines might be in the offing.
References
- .Gewitz MH, Baltimore RS, Tani LY, Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015 May 19;131(20):1806-18.
- Templin C, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929-38.
- Lanza GA, Crea F. Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circulation. 2010 Jun 1;121(21):2317-25.
- Nishimura RA, et al. Mitral Valve Prolapse. N Engl J Med. 2007;356(26):2641-9.
- Sliwa K, et al. Peripartum Cardiomyopathy. Circulation. 2010;121(8):840-50.
- Dunlay SM, et al. Heart Failure with Preserved Ejection Fraction: Drivers and Therapies. JACC. 2017;69(17):1919-1932.
- Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol. 2002;55(7):481-6.
- Abramowitz Y, et al. Mitral Annular Calcification. J Am Coll Cardiol. 2015;66(17):1934-41.
- Warnes CA. Adult congenital heart disease: Specific considerations for women. J Am Coll Cardiol. 2016;68(7):747-760.
- Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890-900.
Dr.S.Venkatesan MD 