Deaths from heart attacks in young women increase during the pandemic

The death by acute myocardial infarction of doctor Ana Carolina Borges Gorga, 30, last month while on duty at a hospital in Cubatão (coast of São Paulo), sparked the alert for the escalation of these deaths in young women during the Covid-19 pandemic.

An unprecedented survey by the SBC (Sociedade Brasileira de Cardiologia), based on data from the Transparency Portal of the National Association of Registrars of Natural Persons (Arpen-Brasil), shows that between 20 and 29 years old, there were 161 deaths in 2021, against 132 in 2020 and 131 in 2019 — an increase of 22%.

Among women aged 30 to 39, the increase was 27% compared to 2020 (638 against 494). In 2019, there were 464 deaths. Between 40 and 49 years old, the jump was 25.3% (2,050 deaths against 1,636). In 2019, there were 1,543 deaths.

Data were extracted from death certificates registered in the registry offices. Official information from the Ministry of Health’s 2021 SIM (Mortality Information System) is not yet available.

The increase in deaths from infarction is also observed among young men in the period. For example, in the 20 to 29 age group, it went from 351 to 440, between 2019 and 2021. From 30 to 39, it went from 1,106 to 1,531. And between 40 and 49 years old, from 3,513 to 4,243.

A study presented at a meeting of the American College of Cardiology shows that, in the United States, the number of heart attacks has stabilized among older Americans, but the incidence among young adults is increasing by 2% per year. The same movement begins to be observed in Brazil. The explanation would be the increase in unhealthy habits, such as a sedentary lifestyle, overweight, smoking and stress – which worsened during the Covid-19 pandemic.

The concern of doctors is that, in relation to young women, there is still a lot of difficulty in recognizing the signs of a heart attack, which are confused with an anxiety crisis, for example. Both for themselves and their families and in hospital emergency rooms.

That’s what happened to nursing assistant Bianca de Souza da Silva, 36, from Rio de Janeiro. She suffered a heart attack on July 29, 2020, two months after having the mild form of Covid. “I started to feel chills, sweating and a lot of pain in my chest. My husband thought it was an anxiety crisis because I had it years ago. But I felt like it was something different.”

As she did not have any cardiac risk factors, the medical team that attended her in the emergency also suspected anxiety and medicated her with an anxiolytic. “I would say: doctor, I’m having a heart attack, I’m having a heart attack. And she would answer: ‘this medicine will calm you down.’ When the blood test results came out, I just remember hearing people yelling CTI, CTI, CTI, she had a heart attack, she had a heart attack. I stayed in the ICU for a week.”

According to interventional cardiologist Esmeralci Ferreira, coordinator of the hemodynamics department at Hospital Universitário Pedro Ernesto, in Rio, where Bianca was transferred for an angioplasty, it is very common for the symptoms of infarction in young women to be neglected by them and their peers, leading to a delay in seeking care.

“This longer time leads to more loss of heart muscle, and the result tends to be worse because there is already a more pronounced thrombus formation”, explains Ferreira.

Cardiologist Gláucia Maria Moraes de Oliveira, a professor at Uerj (State University of Rio de Janeiro), also reinforces that this delay in recognizing infarction in young women also occurs in emergency departments in hospitals.

“There are studies that show that doctors still have difficulty noticing these symptoms. They think women are stressed, anxious, medicate them and then send them away. There are some studies showing that female doctors seem to be more attentive to recognizing these symptoms, and the survival rate of patients ends up being higher.”

Historically, there is an increase in cases and deaths from heart attacks and cardiovascular diseases in women over 50 years old and this is already expected due to menopause. At this stage of a woman’s life, there is a loss of protection that the hormone estrogen gives to the heart. Among other functions, this hormone stimulates the dilation of vessels, facilitating blood flow.

​For cardiologists, the increase in this juvenilization of cardiac deaths from heart attack may also be linked to Covid-19, since research has already shown that the pandemic has increased the risk of cardiovascular diseases. Both for the effects of the infection on the heart and for the worsening of life habits.

It is also Bianca Silva’s justification for the lack of clinical explanation for having had a heart attack at the age of 35 and now carrying two stents in her heart. “My cholesterol is low, I’m not overweight, I eat well, I’m not sedentary, I don’t have hypertension or diabetes, I don’t have a family history of heart disease. two months before the infarction.

For cardiologist Maria Cristina de Almeida, who coordinates the department of coronary disease at the Brazilian Society of Cardiology, regardless of the known effects of Covid-19 on the heart, it is much more likely that this increase in deaths from heart attacks in young women is related to style. of life, which worsened during the health crisis.

“They are stressed, more sedentary, smoking a lot, obese, depressed and this all affects the heart. Not to mention the association between smoking and the use of oral contraceptives. This is poison. With the pandemic, the situation has worsened even more. “

Data from the Surveillance Survey of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel, 2020), 65% of women between 18 and 45 years old are overweight, and about a fifth of them are obese. About 27% have hypertension. The rate of diabetes, another disease that increases cardiovascular risk, has doubled among women aged 24 to 35.

Cleaning lady Adriana de Souza Ferreira, 42, had a heart attack in August 2020. “My life was very busy, stressed, I ate poorly, I smoked a lot, I was overweight, I didn’t exercise. I just kept running from there to here. In the pandemic, got worse, everything got even more difficult”, he says.

She says she didn’t even suspect that her back, chest and arm pain could be symptoms of a heart attack. “Who can imagine having a heart attack at age 40? I thought it was muscle pain. But it got worse, they called an ambulance and, on the way to the hospital, I suffered a cardiac arrest. When I arrived at the hospital, I suffered another.”

According to cardiologist Gláucia de Oliveira, the trend of increasing deaths of young women from heart attacks and other cardiovascular diseases was already observed before the pandemic not only in Brazil but in the United States as well. “With the pandemic, children at home, the workload has tripled. Anxiety, depression, social determinants are much more prevalent in women.”

According to Almeida, from SBC, in general, women do not think they can suffer or even die from cardiovascular diseases. “She’s more loyal to the gynecologist than the cardiologist. She doesn’t know that more people die from cardiovascular disease than from gynecological cancer.”

In Brazil, more than 200 women of all ages die from heart attacks every day. If added to other cardiovascular problems, such as stroke, the number of deaths is six times greater than those caused by breast cancer.

The doctor recalls a very common gynecological problem among young women, polycystic ovary syndrome, which also increases cardiovascular risk.

In general, the syndrome is accompanied by obesity, impaired glucose metabolism, and hypertension. Young women who have had preeclampsia, gestational diabetes, recurrent miscarriages or who have had premature babies are also at increased risk.

According to cardiologist Gláucia de Oliveira, from Uerj, there is currently an “arduous” attempt at partnership between cardiologists and gynecology and obstetrics societies.

“It is necessary that they draw women’s attention to this huge increase in smoking, obesity, serum glucose and sedentary lifestyle. In addition to all of this, they get hypertension ‘for free’. If we don’t do anything, more and more women young people will die.”

Adriana Ferreira, mother of two, says she was never warned about these risks. “It was a big scare. Now I stopped smoking, I’m eating healthier things, vegetables, I eat better, with fruit, vegetables, I walk for at least an hour, I take my medication properly.”

Gláucia Oliveira also recalls that a part of the heart attacks in young women is not related to obstructive coronary diseases. One of the causes is spontaneous coronary dissection. It is a rare condition that generally affects younger people without cardiac risk factors. It can be caused by several factors, such as the use of contraceptives associated with smoking.