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Gender Matters: Heart Disease in Women

Post by on Thursday, August 19, 2021

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Some Key Facts

1. Heart diseases are No 1 killer in women as well
2. Many women present with symptoms which are not very typical (women’s symptoms may be different from man)
3. Women is much more likely than a man to die within a year of having a heart attack
4. Diagnosis in women is more difficult because of atypical symptoms and atypical responses to some heart tests
5. Women don’t seem to fare as well as men do after taking heart medicines (clot-busting drugs) or undergoing some heart-related medical procedures
Even though heart disease is sometimes thought of as a man’s disease, they are now the leading cause of death among women; they present a ‘clear and present danger” especially in post-menopausal age-group. While it is mostly preventable only about half (56%) of women recognize that heart disease is their number 1 killer even in developed world. In a survey in USA only 1 in 8 women reported it as the main killer! Women still worry more about getting breast cancer — even though heart disease kills six times as many women every year.  Table 1 Some facts
Table 1 Some Facts
Heart disease is the leading cause of death for women worldwide causing ~ 1 in every 5 female deaths
Heart disease is the leading cause of death irrespective of race being second only to cancer as a cause of death even among Asians
1 in 30 Asian women (3.2%) have coronary heart disease (the most common type of heart disease)
What are the symptoms of heart disease?
Although some women have no symptoms, most have some symptoms. Many women have atypical symptoms on presentation. Table 2 In women common are:
Anginal Pains 
1. Angina (dull and heavy or sharp chest pain or discomfort)
2. Pain in the neck, jaw, or throat
3. Pain in the upper abdomen or back
These symptoms may happen while resting or doing regular daily activities. 
Other symptoms:
1. Nausea
2. Vomiting
3. Fatigue
Rarely heart disease may be “silent” and not diagnosed until an emergency: 
1. Heart attack: Chest pain or discomfort, upper back or neck pain, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness, and shortness of breath
2. Arrhythmia: Fluttering feelings in the chest (palpitations)
3. Heart failure: Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins
4. Sudden death / Sudden cardiac arrest: sudden collapse or loss of consciousness which may lead to recovery or death
Symptoms in women
Many women don't experience the crushing chest pain that is a classic symptom of a heart attack in men. Rather they feel extremely tired or short of breath. Other atypical symptoms include nausea and abdominal, neck, and shoulder pain. Deep fatigue and disturbed sleep even 1-2 months before a heart attack has been reported. During a heart attack, only about 1 in 8 women have typical chest pain; rather they describe a pressure, aching, or tightness rather than pain.
Table 2 Commonest symptoms in women – 
One month before a heart attack During a heart attack
Unusual fatigue (71%) Shortness of breath (58%)
Sleep disturbance (48%) Weakness (55%)
Shortness of breath (42%) Unusual fatigue (43%)
Indigestion (39%) Cold sweat (39%)
Anxiety (36%) Dizziness (39%)
Heart racing (27%) Nausea (36%)
Arms weak/heavy (25%) Arms weak/heavy (35%)
Risk factors for heart disease
There is generally no single cause for heart disease; rather it is a mix of many ‘risk factors.”
High blood pressure, high LDL (bad cholesterol) cholesterol, and smoking are key risk factors for heart disease. About ½ have at least one of these three risk factors.
Other risk factors are: 
1. Diabetes
2. Being overweight or obesity
3. Eating an unhealthy diet
4. Physical inactivity
5. Drinking too much alcohol
Sex differences in coronary risk factors
Blood lipids. Before menopause, a woman's own estrogen helps protect her from heart disease by increasing HDL (good) cholesterol and decreasing LDL (bad) cholesterol. After menopause, women have higher concentrations of total cholesterol than men do. Elevated triglycerides are also an important contributor to cardiovascular risk in women. Low HDL and high triglycerides appear to be the only factors that increase the risk of death from heart disease in women over age 65.
Diabetes. Diabetes increases the risk of heart disease in women more than it does in men, perhaps because women with diabetes more often have added risk factors, such as obesity, hypertension, and high cholesterol. Although women usually develop heart disease about 10 years later than men, diabetes erases that advantage. In women who've already had a heart attack, diabetes doubles the risk for a second heart attack and increases the risk for heart failure.
Metabolic syndrome. This is a group of health risks — large waist size, elevated BP, glucose intolerance, low HDL cholesterol, and high triglycerides — that increases  chance of developing heart disease, stroke, and diabetes. In women, metabolic syndrome is the most important risk factor for having heart attacks at an unusually early age. It also leads to a greater risk for women than it does for men of dying within eight years
Since many women present with atypical symptoms and have even atypical response to some cardiac tests like stress test, diagnosis is not as straight-forward as in man. Women's responses to standard exercise stress tests are different from men's, so it's difficult to interpret the results.
Since they are older at the time of diagnosis, which is often delayed, their disease becomes more chronic and difficult to treat.  
 Women have smaller coronary arteries than men do which makes all; angiography, angioplasty, and coronary bypass surgery more difficult to do, reducing a woman's chance of receiving a proper treatment and having a good outcome. Women tend to have more complications following surgery. And they're 2 times as likely to continue having symptoms several years after coronary angioplasty. 
So What to do? – “Prevention is better than Cure!”
1. Be more active. Get at least 30 minutes / day of moderate-intensity exercise, such as brisk walking, most days. Fit even more activity into your life: Take the stairs rather than the elevator, do house - work, park farther from your destination and walk.
2. Eat healthfully. There are several crucial ingredients to a heart-healthy diet — whole grains, a variety of fruits and vegetables, nuts (about 20 in number / day), poly- and monounsaturated fats, fatty fish (such as sea fish), and limited intake of trans fats.
3. Reduce stress and treat depression. Your risk for heart disease increases if you're depressed or stressed. Stress-reducing strategies include exercise, adequate sleep, relaxation techniques, and meditation. Psychotherapy can be especially helpful with depression and anxiety.
4. Don't smoke, actively or passively. Chance of having a heart attack doubles if you smoke as few as 1-5 cigarettes per day. Even if you don't smoke, regular exposure to someone else's smoke can increase your risk.

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