User:Vs2022/Cardiovascular disease in women

Traditional risk factors
A number of traditional risk factors for cardiovascular disease have been identified. Age is a non-modifiable risk factor, and the risk of developing cardiovascular disease increases in postmenopausal women due to a reduction in estrogen levels. Modifiable risk factors include smoking, obesity, hypertension, dyslipidemia, and diabetes mellitus.

Smoking
Women smokers face up to a 25% increased risk of developing CAD compared to their male counterparts, with studies showing that reduction in smoking decreased the incidence of CAD in women by 13%.

Obesity
Women make up about 40% of obese adults over the age of 20. Postmenopausal women are more likely to experience fat redistribution to the abdomen and develop metabolic syndrome, resulting in increased susceptibility to obesity.

Hypertension
Estrogen can contribute to maintaining optimal blood pressure in premenopausal women. Consequently, hypertension is frequently seen in older women, especially in black and Hispanic women when compared to white women. Additionally, the prevalence of certain disorders such as fibromuscular dysplasia is increased in premenopausal women and can lead to secondary hypertension. Oral contraceptive use may also be associated with an increase in blood pressure, particularly in individuals already diagnosed with hypertension.

Dyslipidemia
Over 40% of women in the United States have elevated total cholesterol levels, with 30% having elevated LDL levels and 10% of women having low HDL levels. Elevated total cholesterol, elevated LDL, and low HDL have all been implicated in increased CVD risk. Despite the risk of cardiovascular disease, women are less likely to receive appropriate treatment for dyslipidemia.

Diabetes Mellitus
Women with type I diabetes were found to be twice as likely to experience adverse cardiovascular events when compared to men with the same disease and were less likely to receive aggressive treatment to control modifiable risk factors. Women with Type II diabetes are at greater risk than men with the same condition despite similar glycemic control. Studies show an increased risk of cardiovascular disease including myocardial infarction in premenopausal women with diabetes when compared to women without diabetes.

Unique risk factors
In addition to traditional risk factors that contribute to the likelihood of developing cardiovascular disease, women experience additional unique risk factors such as hypertensive diseases of pregnancy, gestational diabetes, and certain autoimmune conditions.

Hypertensive disease of pregnancy
Hypertensive disorders can be seen in 10% of pregnancies, and preeclampsia has been recognized as a risk factor for developing hypertension after pregnancy. Additionally, preeclampsia increases post-pregnancy risk of ischemic heart disease, stroke, heart failure, and overall mortality.

Gestational diabetes mellitus
Women diagnosed with gestational diabetes are at an increased risk of developing traditional risk factors for CVD such as type 2 diabetes mellitus, and hypertension. Moreover, women diagnosed with gestational diabetes remain at higher risk of developing type 2 diabetes mellitus and cardiovascular disease despite blood sugar metabolism returning to normal post-pregnancy.

Other pregnancy-associated conditions
Women who deliver prior to 37 weeks gestation are at increased risk of developing CVD, with additional risk depending on the number and timing of preterm births. Intrauterine growth restriction (IUGR) in prior pregnancies is associated with an increase in maternal CVD risk. Prior pregnancy loss, including miscarriage and stillbirth, also contributed to a two-fold increase in risk of maternal CVD.

Autoimmune diseases
Certain autoimmune conditions such as rheumatoid arthritis (RA) and systemic lupus erythematous (SLE) are significantly more likely to occur in women. Some populations of women are also more likely to be affected than others. For example, SLE is two to four times more prevalent in black women when compared to white women. Studies have shown that women with SLE are at least nine times more likely to experience a myocardial infarction when compared to the general population, with some estimates showing a 50-fold increase in risk. Similarly, RA increases the risk of death from CVD by 50%.

Premature menopause
Menopause is associated with a decrease in estrogen production, and estrogen is thought to be cardioprotective. Premature menopause is defined as menopause prior to the age of 40. Early menopause is correlated with increased CVD risk, although the relationship between the two is complex, and it is unclear whether women experience menopause earlier if they are already at increased risk for CVD.

Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) is an endocrine disorder prevalent in young women that is classically associated with irregular menstruation, androgen excess, and infertility. It is unclear whether PCOS is associated with an increased risk of developing CVD. However, PCOS is associated with multiple traditional risk factors of CVD such as diabetes, obesity, dyslipidemia, and hypertension.

Depression
Women are twice as likely to have depression when compared to men. Studies have shown that women with depression are at greater risk of developing CVD when compared to peers without depression. Depression has also been associated with smoking, a traditional risk factor for CVD.

Epidemiology
CVD remains the most common cause of death for women, with approximately one-third of deaths worldwide attributed to CVD. In 2015, approximately 8.5 million women died from the disease.

In the United States, approximately 47.8 million women over the age of 20 were diagnosed with CVD between 2011 and 2014, and data from 2015 shows over 400,000 deaths due to CVD in women. While overall deaths from CVD are falling, the decline is slower in women, particular black women. The death rate for women with CVD surpasses that of men from CVD. In Europe, over half of the deaths in women are attributed to CVD. The death rate in some Eastern European countries is high, with over 500 deaths per 100,000 population attributed to CVD. Studies predict that in certain developing countries in Asia and Africa, women will account for a greater percentage of deaths related to CVD by 2040.

Cardiovascular disease is more prevalent in older populations. On average, women develop CVD approximately 10 years after their male counterparts. In the United States, approximately 6% of women over 20 have coronary heart disease. The highest prevalence of CVD is present in adults over the age of 80, and women and men have similar rates of disease after the age of 60.