cardiovascular disease in women cardiovascular disease in women cardiovascular disease in women is an integral area of research in the ongoing studies of women's health. cardiovascular disease (cvd) is an umbrella term for a wide range of diseases affecting the heart and blood vessels, including but not limited to, coronary artery disease, stroke, cardiomyopathy, myocardial infarctions, and aortic aneurysms. cardiovascular disease in womenillustration of coronary artery disease comparing a healthy artery to an artery with atherosclerosisspecialtycardiologysymptomschest pain or feeling of crushing pain in the chest; radiating pain in the arms or shoulder; heartburn; pain or discomfort in neck, jaw, upper back, or abdomen; shortness of breath; nausea/vomiting; sudden and random sweating; fatigue; lightheadedness or dizzinessrisk factorstraditional: smoking; obesity; hypertension; dyslipidemia; diabetes mellitus; physical activity; ethnicity and race; socioeconomic status unique: age; hypertensive disease of pregnancy; gestational diabetes mellitus; other pregnancy-associated conditions; autoimmune diseases; menopause; pcos; depression; breast cancer treatment; female sex hormonestreatmentelectrocardiogram; echocardiogram; holter monitor; cardiac magnetic resonance imaging; exercise and nuclear stress tests; cardiac catherization and angiogram; cardiac computerized tomographyfrequency47.8 million (us, 2014)deaths8.5 million (worldwide, 2015) since the mid-1980s, cvd has been the leading cause of death in women, despite being presumed to be a primarily male disease. two types of cvds are shown to be the leading causes of death in women globally according to the world health organization: ischemic heart disease and stroke. however, until recently, the gender-specific data available on cardiovascular disease (cvd) has been sparse for numerous reasons. the risks of cvd were unaccounted for in women due to gender biases, under-representation in clinical trials, and lack of research. these factors contributed to an increase in preventable deaths in women due to cvd. thus, this is now an integral area of research in the ongoing studies of women's health. overall, these factors are instrumental in the key differences seen in cvd presentation, which must be accounted for in diagnostic and treatment practices from healthcare providers. diagnostic gap cardiovascular disease in women may be misdiagnosed or underdiagnosed in women for a number of reasons. cvd, especially heart attacks, often presents symptoms in women differently than in men due to anatomical and hormonal differences. research has shown that women may present with symptoms that are classically associated with heart attacks, such as chest pain and shortness of breath, but also with atypical symptoms such as neck, jaw, arm, or shoulder discomfort, nausea or vomiting, heartburn or indigestion, fatigue, headaches, and palpitations. some healthcare providers may misidentify the causes of these symptoms, attributing them to gastrointestinal or psychological causes instead. moreover, although certain factors traditionally associated with developing cvd include age, hypertension, smoking, diabetes mellitus, and dyslipidemia and are similarly influential on women as on men, recent research has found additional risks that should be added to this list as non-traditional or emerging factors. these include pregnancy-associated disorders such as preeclampsia and gestational diabetes, polycystic ovary syndrome, and even depression. this discrepancy is furthered by the under-enrollment of women in research studies establishing a cvd treatment baseline in women for healthcare practitioners. furthermore, the anatomical features of the cardiovascular system have some differences in size between men and women. the size of the vessels in women is generally smaller in comparison to men. thus, a smaller blockage can cause as much damage to women as a regular-sized blockage in men. women also have a smaller ventricle size than men. this lowers the volume pumped out of the ventricle to the rest of the body, thus requiring their heart to beat faster to ensure a similar amount of blood is pumped out as men. these differences in addition to the cardiovascular functional differences, i.e. a slower fight or flight response, sympathetic activity, and a high rest and digest response, parasympathetic activity, may result in differing presentations of women's illnesses. shifts and trends according to a survey conducted by the aha in 2000, women are now more aware of cvd as the leading cause of death in women than in 1997. close to 90% of women are now aware that women experience heart disease symptoms gradually in later years and that the initial hours of treatment are critical to reducing damage to the brain and heart. this is further supported by a study done in italy in 2022 that found a vast majority of their participants were able to successfully identify cvd as a leading cause of death in women. however, many women are still unaware of the impact of cvd on women's health. this may be due to infrequent exposure to the concerns and a deficit of personalization in education to these groups, and little involvement of women in cvd research until 1986. numerous studies have noted that many women were unable to identify common risk factors or acknowledge whether they were at possible risk of developing cvd, with quite a few even believing that cvd was a male-exclusive condition. this lack of awareness seems to also be prominent in the age groups of 25 to 34 years. nearly 72% of women in this age group consider cancer to be the leading cause of death; however, as age increases, the understanding of heart diseases has also been shown to increase. a national survey conducted by aha in 2012, suggested increased rates of awareness and consciousness. according to the fifteen-year trend report, some of the significant changes are as follows: in 2012 the level of awareness increased in women from different ethnicities with percentages rising up to 65% white, 36% black, and 34% hispanic. in terms of knowledge of the symptoms of heart attack, 18% of women responded with nausea, while 56% responded with chest pain. in case of experiencing a heart attack, 10% of hispanic women were reported to initially take aspirin, compared to 22% black and 18% of white women. the top 3 health management issues were reported to be exercise (by 49% of women), weight (by 47%), and cholesterol (by 45%). analysis of data suggests further improvement in the educational efforts and awareness among women, especially of racial and ethnic minorities, as they face higher mortality rates. as a follow up, a recent 2019 aha survey of the awareness of cvd being the leading cause of death in women has been on the decline in the last decade. the greatest differences were seen among hispanic women, non-hispanic black women and the age group of 25 to 34 year old. these trends are similar to those ones found in the 2012 survey done by the american heart association. this shift in knowledge demonstrates a great need for cardiovascular health programs targeted to women, to ensure that they are able to successfully access the needed resources to ensure successful cvd treatment and prevention. moreover, trends have also demonstrated a difference in cvd risk and treatment amongst women from different ethnicities. in the 1980s, african american women had double the mortality rates compared to other women between the ages 30 to 39. although this number has improved, in comparison to white women, the disparity still persists. a 2007 study that black and hispanic women were nearly half as aware (31% and 29% respectively) than their white counterparts (68%). this is alarming as minority groups have been shown to be at an increased risk of higher cholesterol levels and many other risk factors that cause cvd. studies have found this may be due to lack of educational intervention being targeted to these groups to ensure equity access to health resources. future research is working to establish gender-specific guidelines and ensure that treatments, diagnoses, and overall practices are adjusted to encompass the differences of women with cvd into clinical application. cardiovascular disease diagnoses cvd is an umbrella term to encompass numerous conditions of the cardiovascular system. these can be chronic, i.e. ongoing issues, or acute, i.e. having a sudden onset. there are several different types of cvd, of which the most prevalent are: arrhythmia arrhythmia (also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias) is an irregular heartbeat. the heartbeat is the rate at which the heart beats: too slow (bradycardia) or fast (tachycardia). although it is normal for the heartbeat to fluctuate at times of activity or rest, chronic consistent irregularity may cause not enough blood to reach all parts of the body, as well as put the individual at an increased risk of blood clotting. this can lead to other forms of cvd that may be life-threatening, such as a stroke, if the blood clot travels to the brain. as women typically have more rapid normal heart rates and receive differing electrocardiogram results than men, is important for practitioners to approach these cases differently than men to make a rapid diagnosis. coronary artery disease coronary artery disease (also known as coronary heart disease or ischemic heart disease) is a result of the build-up of substances in the walls of the vessels that provide blood to the heart and parts of the body, the coronary arteries. these substances, which can include cholesterol, cause the vessels to narrow, preventing blood from flowing smoothly through. as the heart compensates for this decrease in blood going out by pumping harder, this can lead to muscle weakness over time, subsequently leading to other life-threatening forms of cvd. the unusual symptoms seen in women with this condition include a sensation of crushing pressure and fatigue – feeling low on energy. congestive heart failure congestive heart failure (chf) is where the heart muscle is unable to pump blood efficiently or at its normal capacity, preventing it from meeting our body's needs. this can cause fluid build-up in various organs, including the lungs and the heart itself, which also makes it life-threatening. women and men tend to present similarly for chf, although women frequently report having more of the symptoms, such as shortness of breath. as well, women typically reflect a normal level of amount of blood pumped from the heart, known as the ejection fraction, which makes diagnosis difficult as it is a crucial sign used to identify chf. myocardial infarction heart attack/myocardial infarction is when the blood flow to parts of the heart is blocked, due to various reasons including plaque build-up, this can cause the heart muscle to die from not being used. this can lead to permanent heart damage, and may even result in death if not treated efficiently. women can present with different symptoms than men, including jaw pain and nausea/vomiting, thus it is important to be alert for unusual symptoms reported by women. peripheral arterial disease peripheral arterial disease: narrowing of the arteries that provide blood to the extremities due to the build-up of plaque. the lack of oxygen and nutrients can lead to tissue death and subsequent loss of the effected extremities. for this disease, women may or may not show signs, i.e. presenting asymptomatically, which can be a challenge in diagnosing. stroke stroke is a result of limiting or blocking the blood supply to a part of the brain, preventing the tissues from receiving the needed oxygen and nutrients to continue to work. this blockage can occur through a blood clot cutting off circulation through an artery – an ischemic stroke –, a blood vessel bursting – a hemorrhagic stroke –, or blood flow is impaired for a certain amount of time – transient ischemic attack. similar to other forms of cvd, symptoms unique to women include nausea/vomiting, shortness of breath, or even seizures. valvular heart disease valvular heart disease is any cvd that is caused by the valves, the door between the chambers of the heart; aortic, mitral, tricuspid, or pulmonary valve. these can be seen as either valve narrowing, also known as or stenosis, or regurgitation, incomplete closing of the valves which leads to leaking of blood backward through the chambers of the heart. of these, mitral regurgitation followed by aortic stenosis are the most common forms found in women. symptoms cvd is the leading cause of death in women worldwide. studies have shown a recent successful decline in cvd mortality overall. however, there is a strong indication for male-specific reductions being implemented in practice, thus female mortality still remains high, despite the incidence of cvd being lower. the number of women surviving and dying from cvd far outweighs the number of men in comparison. due to anatomical and biological differences, women with cvd have been