Pregnancy after the age of 40 increases the risk of heart attack – 05/20/2023 – Health

The high incidence of heart attacks in young women led the SBC (Brazilian Society of Cardiology) to create specific protocols for the prevention, diagnosis and treatment of ischemic diseases of the female heart.

In Brazil, in the age group between 15 and 49 years old, the incidence rate of heart attacks increased from 18.5 cases per 100 thousand women to 19.9 between 1990 and 2019. Currently, one third of Brazilian women of all ages die of cardiovascular disease.

The theme was discussed this Friday (18th) at the first congress focused on women’s cardiovascular health, which took place in São Paulo. The 75-page document exposes the most prevalent cardiac risk factors in the different stages of a woman’s life and what doctors should do to face them.

Women who become pregnant after age 40, for example, have a 20% increase in the risk of having a heart attack during pregnancy.

Although it is an uncommon event in pregnancy, 3.34 heart attacks per 100,000 pregnancies, the data is one more piece in the puzzle that tries to explain the high mortality of young women due to ischemic heart disease in recent decades.

According to cardiologist Gláucia Maria Moraes de Oliveira, member of the executive committee of the department of women’s cardiology at SBC, in addition to late maternal age, there are a number of other factors that may appear during pregnancy, such as diabetes, hypertension and arrhythmias, which increase the risk cardiac.

“Pregnancy is a stress, as if it were a stress test for the woman. At the same time it is a window of opportunity to identify the cardiovascular risks that may manifest themselves during pregnancy or later, throughout life”, says the doctor , one of the coordinators of the new guideline.

The document also draws attention to the risks involved in hormonal contraceptives. It says, for example, that they are effective and safe for healthy women, but there is still little evidence about their effects in women with comorbidities.

A meta-analysis showed that the use of CHC (hormonal contraceptives combined with estrogen and progesterone) represents a 1.7 times greater risk of myocardial infarction and ischemic stroke.

The effect is attributed to the action of estrogen when passing through the liver and promoting changes in hemostatic factors (which keep the blood in a fluid state while circulating) that can favor thrombosis.

The guideline advises that, if the woman has risk factors for cardiovascular disease, CHCs are contraindicated. In these situations, CPP (pure progestogen contraceptives) are recommended.

The document also deals with factors that cause infertility and that may predispose to cardiovascular diseases in women, such as polycystic ovary syndrome (PCOS) and endometriosis.

A meta-analysis that compared groups of women in the same age group, with or without infertility, showed that women with PCOS are at increased risk of obesity, hypertension, glucose intolerance, dyslipidemia and obstructive sleep apnea. In these women, there is an increased risk of myocardial infarction, ischemic heart disease and stroke.

Endometriosis is another cause of infertility that is associated with an increased risk of cardiovascular disease. In the disease, there is a chronic inflammatory process mediated by substances that induce an increase in oxidative stress and LDL-cholesterol, which lead to the formation of fatty plaques on the inner surface of artery walls.

According to the document, fertilization therapy is considered as a potential risk factor for the disorders, but there is still no robust evidence about this association.

For cardiologists, it is very likely that the increase in the incidence and deaths from heart attacks in young women is also related to lifestyle.

Data from the Survey on Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel, 2020) showed that 65% of women between 18 and 45 years old are overweight, and about a fifth of them are obese. About 27% have hypertension. Already the rate of diabetes, another disease that increases cardiovascular risk, has doubled among women aged 24 to 35 years.

Women also have a higher frequency of non-traditional cardiovascular risk factors, such as mental stress and depression, and suffer greater consequences from social disadvantages due to race, ethnicity and income, according to the document.

“There is a lack of awareness among the women themselves. Since the symptoms of a heart attack are not so typical, they delay going to the emergency room. And they also tend not to receive adequate treatment.”

Nursing assistant Bianca de Souza da Silva, 37, from Rio de Janeiro, suffered a heart attack in 2020. “I started to feel chills, sweating and a lot of pain in my chest. My husband thought it was an anxiety attack because I already had it years ago . But I felt like it was something different.”

As she had no cardiac risk factors, the medical team that assisted her in the emergency also suspected anxiety and medicated her with an anxiolytic. “When the result of the blood test came out, I just remember hearing people shouting CTI, CTI, CTI, she had a heart attack, she had a heart attack. I was in the ICU for a week.”

In addition to the most prevalent symptom, chest pain, signs such as tiredness, fatigue, back, neck and arm pain, as well as nausea and vomiting, are common among women.

According to the doctor, when they arrive with these atypical symptoms in an emergency, they are not always associated with a heart attack and then there is a delay in measuring troponins, proteins released in the blood when there is a heart injury, or doing an electrocardiogram.

The confusions do not stop there. “There are changes in the electrocardiogram of women that are different from those of men. There is a reasonable number of infarcts in women without obstructive disease”, explains the cardiologist.

Women with a heart attack also tend to receive less primary angioplasty treatment (artery clearing) than men, sometimes in the same institution. “In women, revascularization of the occluded artery may be more difficult due to bleeding at the access site and smaller, more tortuous coronary arteries.”

According to the cardiologist, the idea is for the new SBC document to guide not only cardiologists but also family doctors, gynecologists and obstetricians, endocrinologists and women in general. “If they don’t seek help, we can’t help either.”