Heart Disease in Women – Facts, Symptoms and Treatment

Women are protected from heart attacks and require a higher risk factor for disease development – this no longer holds true. Present-day scenario is entirely different from this established notion.

According to statistics, the number of coronary diseases in women has increased by 300 per cent in the last five years. There is bad news for women…since arteries in women are narrower; risk factors have a bigger impact. Coronary and heart diseases need to be more aggressively managed in women than men. The mortality rate among women suffering from cardiovascular diseases is also higher than that of men across the world, including India.

  • Experts believe that the main reason for the increased mortality rate in women is the changes in lifestyle in metropolitan cities. In big cities women are working graveyard (late-night) shifts and more and more women are seeking help from smoking and drinking to deal with the stress of their personal and professional lives.
  • Some of the major causes of coronary diseases among Indian women are diabetes, high cholesterol level or dyslipidemia, smoking, bad metabolism and premature menopause or oestrogen deficiency.
  • An independent survey showed that 44.1 per cent women executives in the mean age of 40 in corporate offices across India showed the prevalence of metabolic syndrome, which contributed to heart diseases.
  • It has been proved that diabetes takes away the so-called “female advantage”, or the natural protection present in women of childbearing age. High blood pressure affects men and women equally. Abdominal obesity, increased waist-hip ratio and high levels of cholesterol are also more common in women with heart disease.
  • Another factor most cardiologists stress on is neglect. Women often neglect their symptoms because they are conditioned not to take their health as seriously. In the traditional family, a woman is always the last to take herself to the doctor if she is ill while the main focus in health matters is the children or the husband.

Heart Disease in Women

Heart disease is the leading cause of death amongst women, regardless of race and ethnicity causing the death of one in three women. This amounts to more deaths from heart disease than from stroke, lung cancer, chronic obstructive lung disease and breast cancer combined. A greater proportion of women (52 per cent) as compared to men (42 per cent) with heart attack die of sudden cardiac death before reaching hospital.  Almost two-thirds of women who suffer a heart attack never completely recover.

In a recent survey conducted by the American Heart Association the world over, six in 10 women said that the major threat to their health was breast cancer; only one in 10 said it was heart disease. But, in fact, surveys reveal, each year since 1984, more women than men have died of heart disease.

There are two common misapprehensions held by both women and their doctors: women do not really get much heart disease and, when they do, it behaves pretty much like the heart disease that men get.

The real facts are that heart disease is the number-one killer of women, and when women get heart disease it often acts quite differently than it does in men. Failing to understand these two fundamental facts leads to a lot of preventable deaths and disability in women with heart disease.

A majority of women lack awareness of wellness and health checks, and those living in rural areas are neglected and also lack the facility for early diagnosis of underlying diseases. Worst of all, the symptoms of heart disease – and even the heart disease itself – can be quite different in women than in men. And, since medical textbooks almost exclusively describe “typical” heart disease (that is, the kind that men get), doctors often fail to recognize heart disease when they see it in their female patients. The fact that heart disease is so common in women, and at the same time is underestimated and misunderstood by both women and their doctors, contributes in no small way to their high death rate.

Women actually have narrower arteries as compared to men. This is a fact and it is genetically predetermined. It means it’s a non-modifiable risk factor. In the postmenopausal age group, the narrow size of heart arteries puts women at more risk not only for heart attacks but also heart failure because of repeated heart attacks, stroke and even kidney failures. Indian women, mainly in rural India, remain neglected on their general health issues and for that matter heart health is far beyond their reach.

The onset of disease

The average age of women suffering from the first myocardial infarction (heart attack) is 60 (50-66) and in men it is 52 (45-60) years of age.

The first presentation of heart disease occurs approximately 10 years later amongst women as compared to men and most commonly after menopause. Despite this delay in onset, mortality from heart (coronary artery disease) problem is increasing more rapidly among women than men in both developed and developing countries.

Younger and pre-menopausal women carried mortality excess as compared to similar age group males presenting with myocardial infarction. Presentation of emergency heart problems in women occurs as milder symptoms such as fatigue, dyspnea, nausea, vomiting, and indigestion rather than chest pain. When women have angina, they are more likely than men to experience “atypical” symptoms. Many women report a hot or burning sensation, or even tenderness to touch, in the back, shoulders, arms or jaw; often they have no chest discomfort at all.

Any good doctor will think of angina whenever a patient describes any sort of transient, exertion-related discomfort located anywhere above the waist up to the jaw level, and they really shouldn’t be neglected as “atypical” descriptions. However, because many doctors persist in believing that heart disease is uncommon in women, they are all too likely to write such symptoms off to mere musculoskeletal pain or gastrointestinal disturbances.

During heart attacks, women experience nausea, vomiting, indigestion, shortness of breath or extreme fatigue – but surprisingly many a times no chest pain. Unfortunately, these symptoms are easy to attribute to something other than the heart. Women also are more likely than men to have silent heart attacks – that is attack without any acute symptoms – that are diagnosed only at a later time when subsequent cardiac symptoms are re-evaluated and tests are performed. A routine stress test has low yield in diagnosis due to multiple false positive test.

Heart Attacks in Women

Different treatment outcomes

  • Angioplasty procedure as such remains the same but women more frequently suffer procedural vascular complications as compared to men.
  • In general, women have a higher risk of peri-operative morbidity and mortality after by-pass surgery. This is due to presentation of women at older ages and with more severe heart disease with low heart pumping.
  • However, even at younger ages women may be at slightly higher peri-operative risk than men.
  • Women have more postoperative depression than men but they ultimately recover.

Dietary tips for a healthy heart

  • Cut out saturated and trans-fat intake. You can do this by cutting down drastically on the intake of solid fats such as butter.
  • Choose your protein sources with care. Opt for low-fat protein sources. Meat, poultry and fish along with dairy products and eggs are great sources of protein, but also high in total fat, saturated fat and cholesterol. Make sensible food choices such as skim milk rather than whole milk, skinless chicken breast rather than fried chicken patties and fish rather than red meat. Oily fish like salmon are healthier because they’re rich in omega-3 fatty acids which help lower triglyceride levels and could possibly reduce the risk of sudden cardiac death. Legumes are a good source of protein and have no fat or cholesterol. Soya is another great substitute for animal protein.
  • An apple a day – traditional wisdom had it right. Fruits and vegetables are rich in fibre, nutrients and phytochemicals which are good for health. Eating fruits and vegetables raw quells hunger pangs and makes us less likely to go for high-fat comfort food.
  • Select whole grains: Whole grains such as ragi and jowar are high in fibre which reduces cholesterol levels. They are also important sources of vitamins and minerals, such as thiamin, riboflavin, niacin, folate, selenium, zinc and iron.
  • Finally, be aware of your body. Eat responsibly, exercise diligently, and keep your sugar and cholesterol levels in control either through diet control and exercise or medication if required.

It might just be that edge you need to fight cardiovascular illness, if it ever happens to you.

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