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Women and Heart Disease in Holland

Interview with the Netherlands Society of Cardiology’s Working Group on Gender

‘Heart disease is not a men’s disease only’: Holland goes red to raise awareness during ESC Congress 2013, Amsterdam.

CVD is the leading cause of death in women in most of the European countries; below 75 years, 42 % of women die from CVD compared with 38 % of men (ESC guidelines on prevention of CVD). Following a report from EuroHeart in 2009, the ESC highlighted that the risk for women is largely under-estimated, by both the general population and often by the medical profession itself. This is due to the fact that women usually suffer from CVD 10 years later in their life than men.** Not only that, but the number of young women suffering heart attacks is on the rise (ESC press release for International Women’s Day).

Taking up the cause in Holland

Aimed at raising public and health awareness of this important issue the Dutch Heart Foundation has launched an initiative from 2 to 29 September 2013 with national advertising, events and information distribution throughout cardiology departments and outpatient wards as well as sports events and social media activity. Harriette Verwey from the Dutch National Cardiac Society’s Working Group on Gender, explains why Holland is going red for women and why health professionals also need to wise up to the risks of CVD in women.

What are the main issues concerning women and heart disease?

The odds are against women.
CVD is still the leading cause of death in women despite the decline seen in the past 20 years but there is still no or less awareness of the impact of cardiovascular risk factors in women. Less attention is paid to differences in signs and symptomatology and there is little knowledge about the impact of gestational diabetes, hypertension and eclampsia on the near future of young women.

Traditional risk factors such as smoking, hypertension, diabetes, obesities and psychosocial risk factors also have a greater detrimental effect on women compared to men. 

Common signs and symptoms presentation are less pronounced than in men. This leads to a time delay of 17 minutes for women to reach the hospital in the acute phase of an acute myocardial infarction. The time delay for a cerebrovascular accident is approximately 40 minutes. There is no difference in treatment, yet the overall results of treatment of acute coronary syndromes are poorer than in men. More complications of treatment and more side effects also hamper long-time outcome. Women who suffer from a heart attack at younger age (60 years) have a two times higher risk of dying than men of the same age.

What is the importance of this issue in Holland currently?

Despite the sharp decline in mortality rates, CVD is still the leading cause of death in women in the Netherlands. The decline is less pronounced than in men. In the Netherlands in 2011 a total of 20,651 women died due to CVD - meaning about 1 out of 3 women will die due to CVD. The statistics showed that death due to CVD is 9 times higher than for breast cancer which most women are afraid of.  At present more than 1 million people suffer from CVD and 44 % of them are women.

One out of five Dutch people have a different ethnicity. The majority is less aware of their cardiovascular risk although many of them are at high risk of diseases such as diabetes and hypertension.  Although medical care is at hand they don’t seek help due to lack of awareness, cultural differences, especially women.

What are the key messages you hope this campaign will deliver; firstly to the general public and secondly Dutch health professionals?

The main aim is that women will be better aware of the risks and symptoms and seek help where they otherwise might not have. The real value of the campaign will be awareness and a better understanding of heart disease in women will last way beyond September 2013!

With regards to health professionals, we’d like them to take on board the following:

  • Knowledge about the impact of cardiovascular risk factors on women (Symptoms and signs of CVD may differ in women especially in younger women)
  • Risk detection and primary prevention in women (Testing for CHD in women remains challenging as many of the commonly used diagnostic tests fail to detect the disease)
  • Early detection of coronary artery disease in women (Pregnancy is a stress-test for future CVD risk)
  • Better disease management of CVD and heart failure in women
  • Better economics and policy issues in health care related to women; the role of women’s health centre

* The Women at Heart initiative was launched by the ESC in 2005 to highlight to medical professionals the growing burden and under-appreciation of women’s heart disease and promote improved handling of women at risk of cardiovascular disease in clinical practice.

**The risk increases after menopause, partly because of ovarian hormone deficiency that favours.