Women and valvular heart disease

August 2, 2011

Women have a higher incidence of mitral valve prolapse than men. However, most studies suggest that men are more likely to develop mitral regurgitation, the main complication associated with mitral valve prolapse. If mitral valve prolapse is associated with mitral regurgitation (backflow of blood through the mitral valve of the heart), guidelines recommend antibiotic prophylaxis for dental or other invasive procedures.

Women are preponderant in the very elderly population; they appear to have an increased incidence of calcific AS (narrowing and calcium deposition on the aortic valve), which is a disease of elderly age. Both in this condition and in aortic regurgitation (backflow of blood through the aortic valve), their heart remains smaller in size compared with men. In men, one of the criteria for replacing the valve is enlargement of the heart chamber. Women with aortic valve stenosis (narrowing) develop less ventricular hypertrophy (thickening of the heart ventricle muscle) than men and more often have preserved left ventricular function than men. Women who have even advanced severe aortic regurgitation often do not enlarge their heart at the same rate as men. Therefore, they rarely meet traditional heart enlargement criteria required for valve replacement. This results in operation at a more advanced stage and thus worse outcome. Thus, in women, the timing of surgical replacement of valve should be considered earlier than is often the norm, even if the size of the heart remains relatively small.

Endocarditis is an infectious or inflammatory disease of the heart valves that can lead to damage of the heart valves causing either thickening of the heart valves (stenosis) or backflow/incompetence of the valves (regurgitation). Bacterial infections of the heart valves occur more often in men than in women (1.7:1) and are often associated with injection-drug use, preexistent valve disease (most commonly mitral valve prolapse and artificial valves), older age, poor dental hygiene, long-term dialysis, and diabetes mellitus. However, women are affected twice as often as men with immune, noninfectious endocarditis. These patients usually have Systemic lupus erythematosus, antiphospholipid antibody syndrome (APLAS), or, more rarely, rheumatoid arthritis (Rheumatoid arthritis). Systemic lupus erythematosus involves the heart valves in more than 50% of the patients and can cause valvular thickening, sterile vegetations (small growths on the valves/Libman-Sacks endocarditis), or valvular insufficiency. Once it affects the heart, lupus has a worse prognosis than if it does not involve the heart. Because of the high prevalence of valvular abnormalities in Systemic lupus erythematosus, these patients should receive consideration for antibiotic (prophylactic) treatment for infective endocarditis.

SEE ALSO: Acute myocardial infarction, Cholesterol, Coronary risk factors, Diabetes, Hormone replacement therapy, Hypertension, Oral contraception, Smoking, Stroke, Systemic lupus erythematosus, Venous thromboembolism

Category: Cardiovascular Disease