Since the outbreak of COVID-19, medical communities worldwide have gained insights into how the viral infection and resulting pandemic bear consequences for women’s immediate and long-term cardiovascular health.
Purvi Parwani, MD, director of the LLU COVID-19 Heart Clinic and Women’s Heart Health Clinic, identifies and explains COVID-19's impacts on women's lifestyle and physical well-being — each of which are critical factors in cardiovascular health.
Increased stress during the pandemic affects women’s cardiovascular health
Parwani says the COVID-19 pandemic poses social, cultural, and economic burdens on women, increasing stress and harming heart health.
For instance, she says before the COVID-19 pandemic, women already spent three times more time on unpaid care and domestic duties than men. During the pandemic, this number increased even more, according to data from Latin America and the Caribbean.
In the United States, two out of every three caregivers are women, according to the CDC, and the pandemic creates additional stressors for these women caregivers who are already at high risk of experiencing poor physical and mental health.
Research also reveals that women have suffered increased domestic violence during the pandemic and especially throughout lockdown, Parwani says. Moreover, she says women have experienced a decline in access to essential reproductive and life-saving health services due to health resources diverting toward COVID-19 response.
Women facing escalating responsibilities coupled with simultaneous challenges of violence, declining mental health, or reduced healthcare access take on additional stress in their lives, Parwani says. Experiencing intense or chronic stress in this way can trigger heart attacks and harm cardiovascular health, according to the American Heart Association.
Women are less likely to die of COVID than men but more likely to experience long-term symptoms
Alongside various ways the pandemic’s atmosphere impacts women’s well-being, Parwani says they generally also experience the viral infection itself differently than their male counterparts do.
Gathered data confirm that men with COVID-19 suffer from worse disease progression and mortality than women. Men with COVID are three times more likely to require ICU care than women and 1.4 times more likely to die from COVID than women.
Such differences likely stem from a mixture of possible lifestyle and biological reasons says, Parwani and researchers, such as:
- Lifestyle: More smoking, alcohol use, and obesity in men
- Biological: Genetic and hormonal differences exist between the sexes, which impact immune responses and outcomes of COVID-19 infection — men possess a higher level of ACE2 enzyme activity, for example
Although women have a decreased mortality associated with COVID-19 compared to men, they are more likely than men to experience post-COVID-19 symptoms. Parwani says the same immune pathways that protect most women from requiring critical care for COVID-19 also cause women to be more susceptible to feeling long-term symptoms after infection.
A retrospective analysis of 77,000 US veteran women shows that once women acquire COVID-19 infection, they are twice as likely than pre-infection to experience a heart attack within about two months. In addition, the 60-day cardiovascular events were more likely to happen in women who had been infected and had preexisting cardiovascular disease, kidney disease, or lung disease known as COPD.
Parwani says these long-term symptoms can be life-limiting and range from chest pain, shortness of breath, fatigue, palpitations, decreased capacity to perform daily tasks, dizziness, and loss of consciousness.
Women with cardiovascular complications are not accessing necessary care as much
Fifty percent of heart attack patients stopped going to hospitals during the COVID-19 pandemic due to fears of contracting the virus, according to a worldwide survey by the European Society of Cardiology.
Between 2019 and 2020, data reveal a more than 41% drop in women presenting to medical facilities with a heart attack, compared to a roughly 17% drop in men with heart attacks showing at medical facilities. This is likely not because women are undergoing fewer heart attacks in the pandemic, says Parwani, but rather because women are presenting far less to emergency departments.
Overall, Parwani says the pandemic exacerbates existing gender inequalities in cardiovascular care, acting alongside other aspects like socio-economic status and ethnicity. Further analysis into the gendered patterns and pathways underpinning women’s health in the pandemic is underway, she says.
In the meantime, Parwani says it is essential to remain aware of the many ways COVID-19 infection and the pandemic can impact your short and long-term cardiovascular health in order to protect yourself.
You can learn more from Parwani about COVID-19’s impacts on cardiovascular health and hear from other cardiologists about various heart health topics by visiting lluh.org/heart-vascular/patients-families/heart-month. Also, sign up here for emails to continue learning about heart health for you and your loved ones.