Heart Disease Risk Factors Appear to Disproportionately Affect Women

• New research indicates that certain cardiovascular risk factors could significantly impact females more than males.
• The researchers say taking biological sex into account during routine screenings could provide a clearer assessment of cardiovascular risk.
• Experts say it’s important for females to monitor their risk factors as they age.

The links between blood pressure, diet, exercise, or smoking and heart disease risk have been well established.

Yet new research indicates these risk factors may significantly impact women’s heart health more than men’s.

Researchers say understanding sex-based differences in heart disease risk factors could also help inspire people to make heart-healthy changes. The research has not yet been published in a peer-reviewed journal.

The researchers examined data from over 175,000 adults who participated in the Ontario Health Study between 2009 and 2017, with females making up 60% of the group.

At the start of the study, none of the participants had been diagnosed with heart disease. The study focused on eight established cardiovascular risk factors:

• body mass index (BMI)
• blood pressure
• diet
• physical activity
• sleep
• smoking status
• blood glucose
• lipid levels

Each participant received an assessment for these factors and was categorized as having either ideal or poor health in each category.

Using these individual classifications, the researchers created an overall health profile, ranking participants as having poor, intermediate, or ideal cardiovascular health depending on the number of positive and negative risk factors they exhibited.

Follow-up evaluations occurred over a median period of just over 11 years. The study tracked major cardiovascular events such as:

Findings showed that females tended to have more favorable risk profiles than males. They were more likely to maintain an ideal overall health status, with 9.1% achieving a perfect score across all eight factors, compared to only 4.8% of males.

Conversely, fewer women (21.9%) fell into the poor health category compared to males (30.5%).

Regarding specific risk factors, females were more likely than males to have optimal diet, blood glucose, cholesterol, and blood pressure levels. However, they were slightly less likely to reach ideal physical activity levels.

Despite having generally better health metrics, females who did accumulate more negative risk factors faced a significantly higher risk of severe cardiovascular events than males with comparable risk profiles.

After adjusting for age, the data revealed that both males and females with poor or intermediate cardiovascular health were at greater risk for heart disease compared to those in ideal health. However, the impact was more pronounced in females.

Females classified as having poor health faced nearly five times the risk of heart disease compared to those with ideal health, whereas males with poor health had 2.5 times the risk.

Females in the intermediate health group had 2.3 times the risk, while their male counterparts had 1.6 times the risk.

The researchers emphasized the need for further investigation to determine how biological and sociocultural factors may contribute to these differences in cardiovascular outcomes between males and females.

They also plan to analyze whether the effects of risk factors vary across racial and ethnic groups or in females before and after menopause.

While the study itself couldn’t explain why sex-based differences appear to impact cardiovascular risk, Daniel Atkinson, MD, clinical lead at Treated, suggested a few reasons behind this phenomenon. Atkinson wasn’t involved in the study.

“It’s not fully understood why this is the case, but some research has suggested it might be because of physiological differences between men and women,” Atkinson said.

“Outdated approaches to managing heart disease in women might also be contributing to the issue because, as the study points out, screenings are rarely gender specific,” he noted.

“Heart disease symptoms might present differently in women and could manifest differently at specific stages in their life if hormonal changes do impact things,” Atkinson continued.

Rohit Vuppuluri, DO, an interventional and vascular cardiologist at Chicago Heart & Vascular Specialists, told Healthline it’s “important for women to understand that although cardiovascular disease is higher in men, cardiovascular disease is still a leading cause of death for both women and men.”

However, women are often underdiagnosed, he said, because their symptoms are atypical.

“After menopause, women can have [a] greater risk of cardiovascular disease, and close monitoring of risk factors should occur for women as they become older,” said Vuppuluri.

“Women must also be proactive in managing their lifestyle,” he advised.

Jayne Morgan, MD, a cardiologist and vice president of medical affairs at Hello Heart, pointed to several lifestyle factors that females should seek to manage to promote cardiovascular health. Morgan wasn’t involved in the study.

• Engage in regular physical activity. “Stay active, and have your body in motion. Remember, the human body is made to move,” she said.
• Follow your doctor’s advice. “If you are prescribed medications for blood pressure, cholesterol, diabetes, etc., take them as prescribed and ensure that you meet all goals of measurements,” said Morgan.
• Monitor your blood pressure regularly. High blood pressure is a significant risk factor for both heart disease and stroke, according to Morgan. Keeping it under good control is essential.
• Engage in community. “Longevity, especially with women, has been highly associated with significant relationships with other females within communities,” she said.

Finally, Morgan noted the importance of being aware that women’s heart disease risk rises during perimenopause. She suggested speaking with your physician about any additional steps you may take to protect your heart.