Cardiometabolic Disease: Too Many Women Are Dying Unnecessarily

Sara Gottfried Women's Health Article |Cardiometabolic disease|Cardiometabolic Disease: Too Many Women Are Dying Unnecessarily

Half of the women in developed countries will die of mostly preventable heart disease or stroke.

This is one of several shocking statistics that I encountered while researching my latest publication, “Women: Diet, Cardiometabolic Health, and Functional Medicine,” in which I challenge the dogma that women are at lesser risk of cardiometabolic disease than men.

Heart attack, stroke, diabetes, and insulin resistance belong to this group of common, yet often preventable conditions referred to as cardiometabolic disease.

For most of the past century, more women than men have died from cardiovascular disease–heart attacks and stroke–yet it continues to be considered primarily a problem for men.

How do we turn the tide in a healthcare system that continues to use guidelines and disease parameters that fail to take into account factors that uniquely affect the health of women?

In Women: Diet, Cardiometabolic Health, and Functional Medicine, I present functional medicine as a unique model of care to assess and promote cardiometabolic health. Evaluating women with the systems biology approach that the functional medicine framework provides, we can pinpoint a wider range of, often subtle, cardiovascular risk factors in women that are not sufficiently captured in recent guidelines, such that women’s risk of heart disease and stroke remains underestimated, and deadly.

The traditional risk factors for cardiometabolic disease are:

  • insulin resistance
  • hypertension
  • tobacco use

However, these factors have more serious and deleterious consequences in women—and at equal age, women have more cardiovascular risk factors than men.

What factors require improved evaluation in women to assess their risk of cardiometabolic disease?

Insulin Resistance. Women show adverse effects of elevated fasting glucose at lower thresholds than men. Coronary heart disease risk increases substantially in women with fasting glucose greater than or equal to 110 mg/dL—and this lower cutoff should be considered carefully in female patients

Trauma. Women are more likely to experience trauma, such as adverse childhood experiences (ACEs), which are associated with later risk of cardiometabolic disease.

Oral contraceptives. Combined oral contraceptives increase the risk of acute myocardial infarction (MI) by approximately 5-fold in an older case-control study, primarily in women with known cardiovascular risk factors, such as age, hypertension, or smoking.

Toxin exposure. Mercury exposure may increase risk of hypertension and affects women at lower doses than men.

Pregnancy. Women with complications associated with pregnancy—such as chronic hypertension, preeclampsia, gestational diabetes, prematurity, abruption, preterm delivery, and low birth weight for gestational age—are at greater risk of future development of cardiometabolic disease.

Sleep. Insomnia is 50% more likely to occur in women compared with men. Current evidence links insomnia to an increased risk of incident hypertension, coronary heart disease, recurrent acute coronary syndrome, and heart failure.

Mood Disorders. Women experience higher lifetime risk of anxiety and depression compared with men. Women with depression have a greater relative risk of coronary heart disease incidence compared with nondepressed women.

Caregiver Burden. One of the major gender differences is that women experience greater stress associated with social roles, particularly as primary caregivers. In the Study of Women’s Health Across the Nation, a stressful social role at age 47 to 52 is linked to higher atherosclerotic burden later in life, increasing cardiovascular risk.

Sex difference in symptoms of heart disease

Sex difference in symptoms is a factor in the high mortality rate in women for heart disease. Women are more likely to have atypical symptoms of a heart attack compared to men, including nausea, shortness of breath, fatigue, unexplained weakness, pain in upper back and neck, fainting, sense of foreboding, and generally feeling unwell.

We need to understand sex-based differences in chronic disease and in medical research, and translate our understanding of these differences into clinical practice.

Together, let’s challenge the dogma that women are at lesser risk of cardiometabolic disease than men, or that their risk does not begin until they are 10 years or longer from menopause.

We need a collaborative approach between conventional and functional medicine that transcends silos of care to reconceptualize how we can identify the women at greatest risk from cardiometabolic disease starting at a younger age, and work together more collaboratively to close the gender gap.

One in five women in the U.S. dies of cardiovascular disease. It kills more women than breast cancer. Yet, recent evidence highlights that women are less aware of their risk of cardiovascular disease than they were one decade ago, despite public service campaigns such as “Go Red for Women.”

I’m on a mission to reverse this trend and educate women and men through social media and online platforms, but it takes a village. I’m hoping you’ll join me in spreading awareness about women’s risk of cardiometabolic disease.

My next book is all about trauma—how it gets stuck in the body and mind, leading to chronic cortisol problems, hypervigilence, and even autoimmune conditions (and cardiovascular disease can be considered autoimmune). More soon!

What can you do to improve your cardiometabolic health today and lower your risk of heart disease? Start by tracking your blood sugar levels. Download my free guide here.