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Heart disease is no longer a man’s disease alone – it is the leading cause of death in women globally, more than all the cancers combined yet in women, it is still under recognized and under treated often leading to suboptimal care and poor outcomes, majority of which are preventable. Heart disease may be considered by some to be more of a problem for men however, it’s the common cause of death for both women and men and some heart disease risk factors and symptoms in women can differ from those in men.
In an interview with HT Lifestyle, Dr Teffy Jose, Consultant Cardiology at Aster Medcity in Kochi, shared, “Most common is a heart attack due to blockage which had formed inside a major coronary artery (coronary artery disease). However, women often have chest pain with no evidence of blockage in major coronary arteries – Ischemia with No Obstructive Coronary Artery disease (INOCA) due to disease in smaller blood vessels(microvascular disease). Women are also prone to spontaneous dissections or spasm in coronary arteries and stress induced weakness of the heart (stress cardiomyopathy). Women, especially those with rheumatological diseases can have involvement of their heart valves.”
What are the risk factors?
Dr Teffy Jose revealed, “Women at mid-life near or after menopause are at the highest risk. The hormone estrogen raises the level of HDL (good) cholesterol and helps to keep the arteries flexible. After menopause, drop in estrogen levels occur leading to higher risk of heart disease. Traditional risk factors like high blood pressure, diabetes, high cholesterol levels especially bad cholesterol and smoking are the most important risk factors for heart disease in both men and women.”
She added, “Women with diabetes are more likely to develop heart disease than men with diabetes. 3-fold risk of fatal coronary artery disease is seen in them as compared to non-diabetic women. Emotional stress and depression affect women’s hearts adversely. Also, this may make it more difficult to follow a healthy lifestyle and adhere to the recommended treatments. Additional risk factors include family history of heart disease, obesity and physical inactivity, rheumatological diseases, pregnancy complications such as high blood pressure or diabetes in pregnancy.”
Dr Ravindranath Reddy DR, HOD and Senior Consultant Interventional Cardiologist at BGS Gleneagles Global Hospital in Bengaluru, said, “Several traditional risk factors for coronary artery disease, such as high cholesterol, hypertension, diabetes, smoking, and obesity, affect both women and men, but these traditional risk factors tend to cause more severe disease in women than in men.” Other risk factors that may play a bigger role in the development of heart disease in women include –
• Diabetes: Women with diabetes are two to four times more likely to develop heart disease than men with diabetes and have an increased risk of having a silent heart attack.
• Hypertension: Women over age 60 are more likely than men to have hypertension but less likely to have it managed well.
• Smoking: Women who smoke are three times more likely to have a heart attack compared with men who smoke.
• Dyslipidemia: A low level of HDL cholesterol (“good” cholesterol) is more closely linked with coronary heart disease for women than for men.
• Emotional stress and depression: Women are more likely to experience psychosocial stress and depression, which may play an important role in developing cardiovascular diseases.
• Physical Inactivity: In general, regular exercises are not routinely practiced by women. Lack of physical activity is a major risk factor for heart disease.
• Menopause: Low levels of estrogen after menopause increase the risk of developing disease in smaller blood vessels.
• Pregnancy complications: Pregnancy-associated hypertension, Gestational diabetes greatly raises a person’s risk of developing hypertension, diabetes later in life, which are responsible for developing cardiovascular diseases.
• Peripartum cardiomyopathy: In this condition, which is encountered during pregnancy and the peripartum period, cardiac muscle becomes weak, and chambers get dilated, leading to severe congestive heart failure.
• Family history of early heart disease: This appears to be a greater risk factor in women than in men.
• Autoimmune diseases: Rheumatoid arthritis, lupus, and other autoimmune diseases, which are more commonly seen in women, may increase the risk of heart disease.
• Obesity: Women face a higher risk of obesity when they go through menopause. They’re also more likely to gain abdominal (belly) fat, which is linked to a higher risk for heart disease.
• Polycystic ovary syndrome (PCOS): PCOS raises a person’s cardiovascular disease risk. People with PCOS often develop individual risk factors such as diabetes, high blood pressure, high cholesterol, and sleep apnea.
• Oral contraceptive therapy: Use of oral contraceptive pills may raise a person’s risk for cardiovascular disease.
• Menopause: Estrogen helps reduce a person’s risk of cardiovascular disease but menopause and surgical menopause cause estrogen levels to drop. As a result, a person faces a higher risk for developing cardiovascular diseases.
Symptoms of a heart attack:
Dr Teffy Jose said, “The most common symptom in both men and women is classical chest pain or discomfort which may spread along one or other arm. However, women may experience a wider spectrum of symptoms which may or may not be associated with chest discomfort. This may include jaw, neck or back pain, shortness of breath, nausea or vomiting, upper abdominal discomfort, palpitation, excess sweating, giddiness or fainting or extreme fatigue. Sometimes, a heart attack may be silent especially in elderly or diabetic.”
Talking about what needs to be done for your heart, she suggested, “Women of all ages should take their heart health seriously. Get annual check ups to assess heart health risks. Living a healthy lifestyle reduces your risk of heart disease. Regular moderate intensity aerobic physical exercise of at least 150 minutes /week like walking, swimming or cycling keeps the heart healthy. Including short bursts of jogging or brisk walking in your regular walk gives the additional boost of interval training. Find ways to relax like yoga or meditation and seek help from a professional when stressed out. Eat balanced diet, get at least 7-8 hours of sleep and maintain a healthy weight. Quit smoking and limit your alcohol intake.”
She opined, “In general, treatment of heart disease in men and women is same including medications, angioplasty, or coronary artery bypass surgery. Become knowledgeable about your numbers of blood pressure, blood sugar, blood cholesterol with strict adherence to lifestyle modifications and guideline directed therapy. Recognizing symptoms and risks, making lifestyle changes and getting timely care can save a woman’s life and thus the family and society at large.”
According to Dr Ravindranath Reddy, the most common heart attack symptom in women is the same as in men: chest pain, pressure, or discomfort that lasts more than a few minutes or comes and goes. However, chest pain is not always severe or even the most noticeable symptom, particularly in women. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:
• Neck, jaw, shoulder, or upper back pain
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue
• Heartburn
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