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Health Issues in Women: The Heart Perspective

Post by on Tuesday, March 8, 2022

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 Difference in heart disease between men and women

Many consider heart disease a problem only occurring in men but the reality is that globally heart disease is the most common cause of death for both women and men. Then why this belief? The reason could be that some heart disease symptoms in women can differ from those in men but more importantly it could be lack of awareness in women themselves. Not only the disease is missed in women but it could be more serious in them. 

Women have higher rates of heart failure (HF) and are twice as likely to develop HF with preserved ejection fraction, a disease for which there are still no proven therapies. Moreover, in many areas of cardiovascular disease, even when they are diagnosed women are under-treated compared with men. For example women are less likely to receive statins for dyslipidemia and less likely to receive anticoagulation for atrial fibrillation (AFib).Further, even after heart attack (acute coronary syndrome), they are less likely to be prescribed guideline-directed medical therapy (GDMT), less likely to receive appropriate treatment in a timely fashion, and less likely to undergo angioplasty / surgery. Women also need more help with prevention: among other issues, they are less likely to get an adequate amount of physical activity, more likely to be obese, and less likely to quit smoking compared with men.

Greater awareness of these disparities is a critical first step to improving cardiovascular outcomes for women. 

Heart attack symptoms for women

While the most common heart attack symptom in women are the same as in men (some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes). The difference lies that in women, in many cases chest pain may not be severe and might even not be noticed (in women it's possible to have a heart attack without chest pain). Rather women may have other heart attack symptoms but not chest pain like neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort, shortness of breath, pain in one or both arms, nausea or vomiting, sweating, lightheadedness or dizziness, unusual fatigue or even acidity(indigestion). 

Moreover, even these symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks in men. The reason could be that often women have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart (aka coronary microvascular disease). In women emotional stress can play a major role in triggering heart attack and women tend to have symptoms more often when resting, or even when asleep.

This is the reason that women might be diagnosed less often with heart disease than are men but on the other hand women are more likely than men to have a heart attack with no severe blockage in an artery (non obstructive coronary artery disease).


Heart disease risk factors for women

While most risk factors for coronary artery disease; high cholesterol, high blood pressure and obesity are common for both men and women some other risk factors may play a bigger role in the development of heart disease in women. They are as follows:

1. Emotional stress and depression: Stress and depression is a major risk factor in women, more than men because stress / depression may make it difficult for women to maintain a healthy lifestyle and follow recommended treatment for other health conditions.

2. Physical inactivity: A major risk factor in women.

3. Menopause: Low levels of estrogen after menopause increase the risk of developing disease in smaller blood vessels.

4. Pregnancy complications: High blood pressure or diabetes during pregnancy can increase the mother's long-term risk of high blood pressure and diabetes. These conditions also make women more likely to get heart disease

5. Diabetes: Women with diabetes are more likely to develop heart disease, maybe because diabetes can change the way women feel pain leading to an increased risk of having a silent heart attack (without symptoms).

6. Smoking: Smoking is a greater risk factor for heart disease in women.

7. Family history of early heart disease: This appears to be a greater risk factor in women.

8. Inflammatory diseases: Some inflammatory joint diseases like rheumatoid arthritis may increase the risk of heart disease. 

Although elderly women should take heart disease seriously but even women under age 65, especially those with a family history of heart disease also need to pay close attention to heart disease risk factors.


Heart disease treatment utilization in women

There could be several reasons for treatment underutilization in women:

1. Delayed diagnosis in women: The foremost reason could be that women can present differently than men with certain heart conditions, a knowledge that should be imparted to medical students’ right from beginning of training from medical college onward, where medical students are generally taught the male-pattern of heart disease, like for HF or heart attack / myocardial infarction (MI). Thus when student becomes a treating practitioner he/she misses many things when treating a woman with the female-pattern presentation. 

It must be noted that the clinical practice guidelines are biased towards the male-pattern presentation and this contributes to this mindset, too. This lack of recognition accounts for probably half of the disparities we see; of differing patterns of heart disease is true in coronary heart disease (angina & heart attacks but also in heart failure, where women are more likely to have preserved ejection fraction and men reduced ejection fraction).

2. Differences in diagnostic test results: Stress testing could deliver more false positives (and also false negatives), also even coronary angiographies may mislead because of tendency of more micro-vascular disease in women which is often missed in luminogram of angiography and woen falsely labeled as having no disease, just ‘psychology.’ 

3. Difference in women opting for treatment: Another important issue is that women for several reasons (economics, inherent psychological make-up etc) do not take their own disease seriously and often either refuse treatment altogether or discontinue prematurely. 


Do we need separate guidelines for women?

Are women sufficiently different from men to require a separate discipline? Women are not just small men but they are different. Training and testing may be the best avenues to address this difference. Women's heart health is now included in medical exam curriculum, as well as the internal medicine and subspecialty curriculum like cardiology. This is due to input from key opinion makers and different organizations. Inclusion of test questions on these exams will require that women's heart health is part of the curriculum. Second, even if unisex guidelines are carefully followed we can narrow these health disparities. For example every person – woman or man – who is diagnosed with an AMI leaves the hospital with the same medications prescribed: low-dose aspirin, statins, beta-blockers and, if indicated, an ACE inhibitor. The need is to just follow the guidelines and try achieving best quality possible.

Lifestyle and home remedies

Living a healthy lifestyle can help reduce the risk of heart disease. Try these heart-healthy strategies:

1. Manage stress: Stress is an important cause of not only heart disease but also increases risk of heart attack (rupture of vulnerable plaque). Reducing stress by exercising, yoga and dhyan (practicing mindfulness), listening to soothing music, art and increasing friend circle are some ways to reduce stress.

2. Exercise and maintain a healthy weight: If overweight, losing even a few kilos can lower heart disease risks. 

3. Follow treatment plan religiously: Take medications as prescribed, such as blood pressure medications, blood thinners and aspirin.

4. Quit smoking: Don't smoke, don't start, quit smoking and even avoid exposure to secondhand smoke.

5. Eat a healthy diet: Opt for whole grains, raw fruits and vegetables, low-fat or fat-free dairy products, and white meats. Avoid saturated or trans fats, added sugars, and high amounts of salt.

6. Avoid or limit alcohol: Drink in moderation or avoid completely. Limit to 1 drink per day. 

7. Manage risk factors: High blood pressure, high cholesterol and diabetes increase the risk of heart disease.


Exercise and heart health

Women are especially susceptible to physical inactivity. Regular activity helps keep the heart healthy. Aim for at least 30 minutes of moderate exercise, such as walking at a brisk pace, on most days of the week. If that's more than you can do, start slowly and build up. Even five minutes a day of exercise has health benefits.

If unable to do at a stretch, break up your workouts into several 10-minute sessions during a day. Another option is interval training: alternate short bursts of intense activity with intervals of lighter activity. Moderate exercise can maintain a healthy weight, improve blood pressure and thus reduce risk of heart diseases. 

Useful exercise tips for all:

1. Take the stairs instead of an elevator.

2. Walk or ride your bike to work or to do errands.

3. Keep walking while watching TV.

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