Heart disease is the leading cause of death in both men and women worldwide. The prevalence of heart disease has increased over time in both men and women. The myth that heart disease is a ‘man’s disease’ needs to be debunked.
In coronary artery disease, the coronary arteries become narrowed or blocked by a gradual build-up of fat (cholesterol) and other substances within the artery wall. This build-up is called atherosclerotic plaque. This narrows the arteries, making it harder for blood to flow through. If a plaque erodes and a blood clot forms, it can stop the blood flow. This can cause a heart attack. Heart disease can take many other forms. It can result in heart failure due to weak and damaged or stiff heart muscles, arrhythmia (abnormal rhythm of the heart), and heart valve problems.
Women generally have their first presentation of heart disease a decade later than men, commonly after menopause. Women are less likely to call emergency service when experiencing symptoms of a heart attack themselves and are much more likely to die from their first heart attack than men. The most common heart attack symptom is pain, pressure or discomfort in the chest. It may not be always severe or even the most prominent symptom. Symptoms of heart attack in women can be different to men. It is important to understand these differences as they can result in delay in seeking help or treatment and, thus, may lead to more complications. Heart attacks can also be silent. Symptoms unrelated to chest pain may be:
¨Shortness of breath
¨Neck, jaw, shoulder, upper back or abdominal discomfort
¨Pain in one or both arms
¨Nausea or vomiting
¨Sweating
¨Dizziness or light-headedness
¨Unusual or extreme fatigue
These symptoms can be commonly attributed to indigestion, stress and weight gain. Women can have symptoms of chest discomfort due to blockages not only in their main arteries but also in the smaller arteries that supply blood to the heart, a condition called small vessel heart disease or microvascular disease. There are several factors which increase the risk for developing heart disease, such as high bad cholesterol (LDL and triglycerides) and low good cholesterol (HDL), high blood pressure, obesity, diabetes (women with diabetes are at greater risk than men with diabetes), smoking (greater risk factor in women than in men), and lack of physical activity.
Other factors include stress and depression, which make it difficult to maintain a healthy lifestyle and follow recommended treatment. Manage stress levels by finding healthy ways to cope with stress like yoga and meditation or seek medical help. Menopause (because of low levels of oestrogen), certain chemotherapy drugs and radiation therapy for cancer, pregnancy complications and broken heart syndrome (more commonly in post-menopausal women) are also risk factors.
Women of all ages should take heart disease seriously and women under the age of 65, especially those with a family history of heart disease, should pay heed to the risk factors. They can make several lifestyle changes to reduce the risk of heart disease such as quitting smoking, and managing diabetes, blood pressure and cholesterol. Staying active is another must. Everybody without a physical disability should do moderate exercise, such as walking at a brisk pace or any aerobic activity, most days of the week. At least 150 minutes of moderate aerobic activity a week or 75 minutes of vigorous aerobic activity a week, or a combination of both is recommended. That is, about 30 minutes a day, five days a week. For more health benefits, aim for 60 minutes a day, five days a week. Also aim to do strength training exercises two or more days a week. If you cannot get all the exercise completed in one session, try breaking up your physical activity into several 10-minute sessions during a day. Also, make other small changes to increase physical activity throughout the day. Try taking the stairs instead of the elevator, walking or riding your bicycle to work or doing situps or pushups while watching television.
Losing weight even slightly can help by lowering your blood pressure and reducing your risk of diabetes. What is considered a healthy weight varies from person to person, but having a normal body mass index is helpful. Measuring waist circumference and calculating the waist-hip ratio is a useful tool to measure whether you are overweight.
A healthy diet is vital. Include whole grains, a variety of fruits and vegetables, low-fat or fat-free dairy products and lean meats. Avoid saturated or transfat, added sugars and high amounts of salt. Limit alcohol intake to no more than one drink a day. Recent data, however, indicate that even that may be harmful.
Treatment in women and in men is similar. It may include medication, angioplasty and stenting, or coronary bypass surgery. However, women who do not have chest pain are less likely to be offered these potentially lifesaving options. It would be prudent to note that hormone therapy, antioxidant vitamin supplements (vitamin E, C and beta carotene), and folic acid, with or without B6 and B12 supplementation, should not be used for the primary or secondary prevention of cardiovascular disease. Routine use of aspirin in healthy women 65 years of age is not recommended to prevent heart disease.
All women should work with their health care provider to make a plan for ensuring heart health. No matter what the routine is, a list of all medicines and questions to be asked should be brought along for all the appointments.
The writer is director, cardiology, Fortis Memorial Research Institute, Gurugram.