Stroke and heart attack, from diet to drugs for men and women, prevention does not change
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Statins for him, physical activity and diet for her. To control cardiovascular risk, there is the possibility that gender strategies may be chosen even in the face of guidelines that indicate a substantially overlapping approach for men and women. This trend could also impact outcomes in terms of heart attack and stroke prevention. to warn, figures in hand, is a research presented at the congress ESC Asia. The study was coordinated by First Wulandari of Harvard University and Massachusetts General Hospital in Boston, which reports that it has been found that “women are advised to lose weight, exercise and improve their diet to avoid cardiovascular disease, but men are prescribed lipid-lowering drugs” .
For women’s hearts, there is a need for tailor-made therapies
by Federico Mereta
Less attention to primary prevention in women?
The research took into consideration information relating to over 8500 people involved in the US National Health and Nutrition Examination Survey (NHANES). These were people of both sexes between 40 and 79 years of age with no history of cardiovascular pathologies: just under 3,000 of these subjects had a risk profile such as to require the administration of statins as a preventive measure.
In this population of 2,924 participants, the researchers assessed the likelihood that men, compared with women, were prescribed statin therapy and received advice on losing weight, exercising, reducing salt intake, and reducing fat intake. or calories. Result? The analysis showed that men were 20% more likely to receive statins than women. Compared with men, women were 27% more likely to receive weight loss recommendations and 38% more likely to receive exercise recommendations. Regarding nutrition, women were advised 27% more than men to reduce salt intake and 11% more often received the indication to reduce the consumption of fat or calories.
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What the guidelines say
The guidelines of the European Society of Cardiology (ESC) for cardiovascular prevention start from the recommendation to fight a sedentary lifestyle. For all adults and at all ages they are needed at least 150 to 300 minutes of physical activity with moderate-intensity or 75 to 150 minutes of vigorous-intensity, aerobic physical activity per week, or an equivalent combination. Equally important is saying goodbye to cigarettes. On the nutritional front, the recommendation is for a healthy diet, with a preference for foods of plant origin such as whole grains, fruit, vegetables, legumes and nuts.
As far as table salt is concerned, it is important to limit its intake to less than 5 grams in 24 hours. Furthermore, for those with specific risk factors such as hypercholesterolemia and hypertension, it is always necessary to combat overweight and hypertension, dyslipidemia and possible diabetes. Statins, which are discussed extensively in the paper, are recommended based on individual characteristics including age and risk of developing heart disease. And certainly not on the basis of gender, even if it seems that there are targeted pathways for men and women in the doctors’ approach.
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Prevention is tailor-made
Explaining this trend of less use of pharmacological treatments for women than for men is not easy. According to American experts, in any case, “a potential root of the discrepancy in advice is the misconception that women have a lower risk of cardiovascular disease than men.” This is not the case, even if unfortunately the danger of heart attack and stroke is more often underestimated by the fairer sex and not just in prevention. Even relatively young women, in terms of dangers, would be more exposed to worse prognosis compared to peers within the hospital. To say it is a study presented some time ago by the experts of the Mayo Clinic, published on Mayo Clinic Proceedings.
The research examined a huge amount of data, relating to over 6.7 million people hospitalized for a heart attack, arriving at drawing the differences by sex, and by age, in the prognosis after a heart attack. It emerges that the risk of heart attack for women increases with advancing age and, in the study, the net “overtaking” of the female sex compared to the male one for the diagnosis of heart attack occurs after the age of 84, also considering the higher average life expectancy for women. But it must be remembered that the “weight” of the risk factors would still be slightly different in the two sexes.
For women who had a heart attack, in general, they were more likely to have a history of hypertension, diabetes, atrial fibrillation and chronic respiratory disease, as well as a previous stroke. Unfortunately, as can be seen in the analysis presented at ESC Asia, at times attention to prevention is less in the fairer sex. The same trend, according to the survey from the USA, is also observed at the time of treatment, with globally “worse” treatments for outcomes in women compared to men.
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