Sao Paulo – The death by acute myocardial infarction of doctor Ana Carolina Borges Gorga, 30, last month while on duty in a hospital in Cubatão (São Paulo coast), triggered the alert to the escalation of these deaths among young women during the Covid-19 pandemic.
An unpublished investigation by SBC based on data from the Transparency Portal of the National Association of Registrars of Natural Persons (Arpen-Brasil), shows that between the ages of 20 and 29, there were 161 deaths in 2021, compared to 132 in 2020 and 131 in 2019 – an increase of 22%
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An unpublished survey by the SBC (Sociedade Brasileira de Cardiologia), based on data from the transparency portal of the National Association of Registrars of Natural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 the ages of 20 and 29 there have been 161 deaths in 2021, compared to 132 in 2020 and 131 in 2019 – an increase of 22%.
Among women aged 30 to 39, the increase is 27% compared to 2020 (638 against 494). In 2019, there were 464 deaths. Between ages 40 and 49, the jump was 25.3% (2,050 deaths versus 1,636). In 2019, there were 1,543 deaths.
Data were extracted from death certificates registered at vital statistics offices. Official information from the Ministry of Health’s SIM 2021 (Mortality Information System) is not yet available.
The increase in death by heart attack is also observed among young men of the period. For example, in the age group of 20 to 29, it increased from 351 to 440, between 2019 and 2021. From 30 to 39, it increased from 1,106 to 1,531. And between 40 and 49 , from 3,513 to 4,243.
MOVEMENT IN THE UNITED STATES
A study presented at an American College of Cardiology meeting shows that in the United States, the number of heart attacks has stabilized among older Americans, but the incidence in young adults is increasing by 2% per year. The same movement is beginning to be observed in Brazil. The explanation would be the increase in unhealthy habits, such as a sedentary lifestyle, being overweight, smoking and stress – which have worsened during the Covid-19 pandemic.
SIGNS OF INFARCTION
The concern of doctors is that, compared to young women, it is still very difficult to recognize the signs of a heart attack, which are confused with an anxiety attack for example. For themselves and their families and in hospital emergency rooms.
That’s what happened to caregiver Bianca de Souza da Silva, 36, from Rio de Janeiro. She had a heart attack on July 29, 2020, two months after having the mild form of Covid. “I started having chills, sweating and lots of pain in my chest. My husband thought it was an anxiety attack because I had it years ago. But I had felt like it was something different.”
‘DOCTOR, I THINK’
As she had no cardiac risk factors, the medical team who treated her in the emergency room also suspected anxiety and medicated her with an anxiolytic. “I was like, Doctor, I’m having a heart attack, I’m having a heart attack. And she was like, ‘This medicine will calm you down.’ When the blood test results came out, I just remember hearing people screaming CTI, CTI, CTI, she had a heart attack, she had a heart attack, I was in intensive care for a week.
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According to interventional cardiologist Esmeralci Ferreira, coordinator of the hemodynamics department at the Universitário Pedro Ernesto Hospital, 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, resulting in a delay in treatment.
“This longer time leads to more heart muscle loss, and the outcome tends to be worse because there is already more pronounced thrombus formation,” Ferreira says.
The cardiologist Gláucia Maria Moraes de Oliveira, professor at the Uerj (State University of Rio de Janeiro), also points out that this delay in recognizing the infarction in young women also occurs in the emergency services of the hospitals.
“There are studies that show doctors still have a hard time noticing these symptoms. They think women are stressed, anxious, treat them and then fire them. Some studies show that female physicians seem to be more attentive to recognizing these symptoms, and patient survival rates end up being higher.”
JUVENILIZATION OF DEATH
Historically, there is an increase in cases and deaths from heart attacks and cardiovascular disease in women over 50 and this is already expected due to menopause. At this point in 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 circulation.
For cardiologists, the increase in this juvenilization of cardiac death by infarction could also be linked to Covid-19, since research has already shown that the pandemic has increased the risk of cardiovascular disease. Both for the effects of the infection on the heart and for the worsening of life habits.
This is also Bianca Silva’s justification for the lack of clinical explanation for having a heart attack at the age of 35 and now having two stents in her heart. “My cholesterol is low, I’m not overweight, I eat well, I’m not sedentary, I don’t have high blood pressure 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 coronary heart disease department at the Brazilian Society of Cardiology, whatever 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 linked to lifestyle, which has worsened during the health crisis.
“They are stressed, more sedentary, smokers, obese, depressed and all of this affects the heart. Not to mention the association between smoking and the use of oral contraceptives. It’s poison. With the pandemic, the situation s is further aggravated”. . “
According to data from the Chronic Disease Risk and Protective Factors Surveillance Survey by telephone survey (Vigitel, 2020), 65% of women between the ages of 18 and 45 are overweight, and around a fifth of them are obese. About 27% suffer from hypertension. The rate of diabetes, another disease that increases cardiovascular risk, has doubled among women aged 24 to 35.
“WHO CAN IMAGINE A MIRACLE AT 40? »
Housekeeper Adriana de Souza Ferreira, 42, suffered a heart attack in August 2020. “My life was very busy, stressed, I ate badly, I smoked a lot, I was overweight, I didn’t do exercise. In the pandemic, it got worse, everything became even more difficult,” he says.
She says she didn’t even suspect that her pain in her back, chest and arms could be symptoms of a heart attack. “Who can imagine having a heart attack at 40? I thought it was muscle pain. But it got worse, they called an ambulance and on the way to the hospital I had a cardiac arrest. When I got to 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 also in the United States. “With the pandemic, children at home, the workload has tripled. Anxiety, depression, social determinants are much more present in women.”
According to SBC’s Almeida, women generally don’t think they can suffer or even die from cardiovascular disease. “She is more loyal to the gynecologist than to the cardiologist. She doesn’t know that more people die from cardiovascular disease than from gynecological cancers.”
HARD ATTEMPT AT PARTNERSHIP
In Brazil, more than 200 women of all ages die of heart attacks every day. If added to other cardiovascular problems, such as stroke, the number of deaths is six times higher than that caused by breast cancer.
The doctor recalls a very common gynecological problem in 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, repeated miscarriages, or had premature babies are also at increased risk.
According to cardiologist Gláucia de Oliveira, from Uerj, there is currently an “arduous” attempt to partner cardiologists with gynecology and obstetrics societies.
“There is a need for them to draw women’s attention to this huge increase in smoking, obesity, blood sugar and physical inactivity. On top of all that, they are getting high blood pressure ‘for free’. If we do nothing, more and more young women will die.”
Adriana Ferreira, a mother of two, says she was never warned of these risks. “It was a big scare. Now I quit smoking, I eat healthier things, vegetables, I eat better, with fruits, vegetables, I walk at least an hour, I take my medicine correctly. “
Gláucia Oliveira also recalls that part of the heart attacks in young women is not linked to obstructive coronary diseases. One of the causes is spontaneous coronary dissection. It is a rare disease that usually affects younger people without heart risk factors. It can be caused by several factors, such as the use of contraceptives associated with smoking.
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