Why women’s risk is higher than men

The study tracked and reviewed medical claims between 2005 and 2022, analyzing more than 4 million patients’ rates of depression and eventual CVD diagnosis.

There were slightly more men in the study than women. The average age was 44 years old. To qualify for a depression status in the analysis, the participant had to receive a clinical diagnosis prior to their CVD diagnosis.

Patient health data included body mass index, blood pressure, fasting cholesterol, and blood glucose levels. Cardiovascular events included myocardial infarction (heart attack), angina pectoris (recurring chest pain), heart failure, and atrial fibrillation.

Researchers used data to calculate multiple “hazard ratios”— which simply indicate a person’s risk of something occurring — in men versus women.

The results suggest that the hazard ratio of a depression diagnosis leading to CVD was 1.39 in men and 1.64 in women. The ratio of depression leading specifically to a heart attack, chest pain, stroke, heart failure, and other incidents were all higher for women than men.

Researchers acknowledged the study included several clear limitations.

Among them was the fact they were unable to gather specific details on participants’ depression symptoms or the potential influence of COVID-19. In addition, the study was observational, which means it is unable to establish causality between depression and CVD.

While heart attacks are often associated in society (and the movies) with men more than women, the risk is equal for both genders.

The statistics on receiving treatment and dying from a heart attack, however, is less favorable for women.

“I was so happy to see that we’re finally doing research on this, but it points out several critical points,” said Dr. Evelina Grayver, a cardiologist and director of Women’s Heart Health at Central Region Northwell Health who wasn’t involved in the study.

“Cardiovascular disease is the number one cause of death in women,” Grayver told Medical News Today. “It kills more women than breast, lung, and colon cancer combined. But so many women dismiss their symptoms because women do not present with typical heart attack symptoms.”

Instead of pain in the left arm or the sensation of an “elephant sitting on your chest,” Grayver said women are more likely to feel tightness in their chest, shortness of breath, fatigue, and abdominal discomfort.

Past research from the American Heart Association points out that women are 20% more likely to die within the first five years after a severe heart attack. It also notes that women were less likely to be seen in the hospital by a cardiologist and were less likely to receive prescriptions such as beta blockers and cholesterol medications.

Women are twice as likely to be diagnosed with depression than men.

The big question is why.

Researchers in the new study theorize that women may experience more severe and persistent symptoms. This increased intensity could further influence lifestyle habits that contribute to a person’s heart attack risk.

Women also face more unique health challenges around pregnancy and menopause. These hormonal fluctuations can easily contribute to mental health issues such as depression, anxiety, and general stress.

Women also have significantly higher rates of metabolic syndrome, which includes classic risk factors for CVD such as high blood pressure, diabetes, and obesity.

“I appreciate the effort this study made to understand why women have this higher risk of CVD and why depression increases that risk,” said Grayver. “They acknowledge that women experience longer, deeper periods of depression.”

Grayver highlighted two contributing concerns: inflammation and hormonal fluctuations.

“Depression and anxiety are stressors, and they create inflammatory havoc in your body. That inflammation causes a significant rise in your cortisol levels and inflammatory cascade that affects cardiovascular vessels,” said Grayver. “But your cardiovascular system extends beyond your heart. It’s all the vessels. The carotid artery in your neck, down through your heart, through the vessels in your entire body.”

Chronic stress, depression, and anxiety can lead to persistent inflammation that can harden those vessels and the build-up of plaque.

“Yes, we know that women with depression have a higher risk of obesity and diabetes, but we know there are also significant gender-specific risk factors here,” explained Grayver. “Women need to be treated based on their reproductive age. A woman’s risk of depression in her reproductive phase is different than the perimenopause, menopause, or post-menopause phase.”

Grayver said the normal hormonal fluctuations women experience through the transition to menopause play a significant role in mental health as well as cardiovascular health. Estrogen is known to relax arteries and promote the production of good “HDL” cholesterol.

“When your heart starts to lose that protection of estrogen while those hormone fluctuations are also affecting your mental health,” she added. “This is a very common time for women to develop anxiety and depression disorders.”

“The world of medicine has become way too sub-specialized,” said Grayver. “When we see a patient in cardiology, we must treat the whole person. Every sub-specialist should have depression screening and assessment tools.”

“Within the world of sub-speciality, we still have to treat the person as a whole being and not hesitate to talk about mental health,” she added. “That hesitation is on both parts, on the physician and the patient.”