Mandic: heart failure in women, the main causes and how it should be addressed

“World Heart Day” is celebrated every year on 29 September. FondazioneOnda, the national observatory on women’s and gender health, organized the(H)Open Week, dedicated to cardiovascular diseases in order to promote information and prevention. The initiative was also joined by ASST Lecco, which in the scientific meeting room of the Mandic Hospital in Merate proposed a meeting entitled “Heart failure in women: how to deal with it, how to cure it”, which saw the doctor Maria Grazia Gorgoglionecardiologist of the Complex Operative Unit of Cardiology, supported by the director of the Unit, il Dr. Stefano Maggiolini.

Il Dr. Stefano Maggiolini

Doctor Gorgoglione immediately framed what is meant by heart failure, a disease for which the heart is fatigued and cannot perform its correct work as a “pump”, thus not guaranteeing a correct blood supply to the other organs. “Cardiovascular disease is the leading cause of death in our country, explained the doctor. Reason why we must be careful and prevent. One in three women dies of ischemic heart disease. Two out of three women with diabetes die of ischemic heart disease.”

What happens in the body and blood vessels of men is not the same as what happens in women, and this differentiation has to do with sex. “Sex steroids, estrogens and androgens, and their receptors are the fundamental determinants of gender differences in the cardiovascular system. Estrogen functionality is essential for maintaining normal function of the vascular endothelium.”

Doctor Maria Grazia Gorgoglione

It is therefore for this reason that coronary heart disease is less common in women of childbearing age than in men, but remains an important risk factor. However, this does not apply to all women. In fact, an obese woman, even a young woman, is at greater risk of heart failure, especially if she is concomitant with a metabolic syndrome. For all women, however, menopause certainly marks an important moment. “It is a natural phase that in addition to the cessation of menstruation is characterized by a reduced ovarian function, with the absence of ovarian follicle production and reduced estrogen production. In addition to possible symptoms such as hot flashes, the hormonal changes that occur in this phase also determine the increase in fat mass, especially in the abdominal area “explained Dr. Gorgoglione.

This thing should not be underestimated, because the visceral adipose tissue produces numerous substances that stimulate inflammation and favor the onset of arteriosclerosis, heart disease and cancer. In addition, they reduce insulin sensitivity, favoring type 2 diabetes mellitus. “With a delay of ten years compared to the man, in this phase also the woman can develop cardiovascular problems, such as arterial hypertension, second type diabetes mellitus and hypercholesterolemia”. It is important for women in this phase to take care of themselves, because it is not uncommon for psychological and socio-cultural aspects – anxiety, depression, caring role in the family – to tend instead to put their own care last.

There are two categories of decompensation, that due to a reduction in cardiac contractility, associated or not with dilation of the ventricles, with a reduction in the ejection fraction of the left ventricle, and decompensation with an increase in filling pressures. In men, decompensation secondary to ischemic heart disease prevails, in women decompensation secondary to hypertension and diabetes prevails. Whatever the type of decompensation, what everyone must pay attention to are the symptoms, which are always due to the reduction of the heart’s power and the stagnation of fluids in some organs. The main symptoms are wheezing, chronic lack of energy, difficulty sleeping at night due to breathing problems, swollen abdomen and palpitations. “What can be done to prevent all this? – asked the doctor. – It is important to avoid smoking, to continue or start exercising after menopause, to walk in the fresh air, to monitor blood pressure and to do control exams by consulting with your general practitioner “. Finally, the doctor recalled that the symptoms may still be absent in the so-called pre-clinical phase of the disease, which can therefore only be identified by chance or by deepening investigations. Early diagnosis in this sense is extremely useful for implementing all clinical-therapeutic measures. This diagnosis is made thanks to the electrocardiogram, the echocardiogram and the blood dosage of Bnp.