The heart truth for women

People think that heart diseases are primarily men's diseases but the data from all over the world indicates that the heart disease is a leading killer of women. They are more likely to die of a heart attack than men, and those who survive the first attack, have higher chances of a recurring heart attack and subsequent death...

By Dr Sumera Naseem

Many people are under the impression that heart diseases are primarily men's diseases. But here is the blunt truth. Data from all over the world indicates that coronary artery disease or simply 'the heart disease' is a leading killer of women. Almost twice as many women die of cardiovascular disease than from all cancers combined. Women are more likely to die of a heart attack than men, and those who survive the first attack, have higher chances of a recurring heart attack and subsequent death. Women need to understand that the risk of having a heart attack, stroke or other cardiovascular diseases is the same for them as it is for men. While it is important to prevent breast and ovarian cancer, heart disease prevention among females is a subject of prime importance in today's environment.

Women's heart disease differs from men's in terms of the risk factors, symptoms and intensity. However, the public and health care providers are often unaware of these differences. Women develop heart diseases seven or eight years later in life as compared to men. However, after 65 years of age, both men and women are at the same risk. The most important risk factor for women is abnormally high blood pressure (hypertension): the higher the blood pressure, the greater the risk. The optimal blood pressure should be less than 120/80 mmHg. There is a higher prevalence of hypertension in the female population in Pakistan than in men and a significant number of our women have poor control of hypertension, which can be a consequence of multifaceted issues ranging from lack of awareness due to cultural bounds and social taboos restricting access of females to health care.

Cholesterol level is an important predictor of heart disease for both genders but there are some differences for example in women, the level of good cholesterol is a better predictor of heart disease than the high level of bad cholesterol. The presence of Diabetes Mellitus increases the risk of heart disease in women two-fold as compared to men. Smoking is an equally important risk factor for women. More than half of total heart attacks in women of less than 50 years age are related to smoking.

Hormonal medications or pills also increase the risk of heart disease and this risk will be doubled if smoking is already implicated as a risk factor. Obesity is another important risk factor for heart disease in our women population - extra weight puts strain on the heart and arteries. Being overweight means that a woman has a higher propensity for developing major health problems like diabetes, high blood pressure and heart disease. The relative risk of mortality by coronary heart disease is eight times higher in women who accumulate fat and become obese in the central portions of the body such as the tummy, hips, and around the waistline. It therefore becomes extremely important for every woman to know not only their waist circumference, but also the Body Mass Index (BMI). The ideal BMI for our women is 18.5-23 kg/m? and waist circumference less than 32 inches.

Remember, our heart is a muscle, which needs regular exercise to stay in shape. Exercise not only helps our heart but also lowers the risk of stroke, osteoporosis, and hot flashes during menopause and helps prevent early wrinkling of skin. We should therefore exercise moderately like a brisk walk for at least 30 minutes per day.

Preparing good and delicious food for family is always a priority for a good wife or mother, but what is important for our heart is good and healthy food, which must contain fruits, vegetables and whole grains. Olive oil or canola oil should be the main source of fat calories and meat should be treated as a condiment, not an entrÈe.

Will medicines lower the risk of heart disease in women? There are certain medicines, which will reduce the risk in men but not in women. For example, cholesterol-lowering medicines reduce the risk of heart attacks in men, but there is not enough evidence to show that these medicines work as well in women who have never had a heart attack. Similarly, taking an aspirin 75 mg every day reduces the risk of having a heart related problem if coronary artery disease is already established or if the woman is older than 65 years of age regardless of the presence of heart disease. However, the specific benefit varies with sex, for instance, with the daily use of aspirin; women younger than 65 years of age experienced a decrease in stroke risk and no decrease in heart attack risk whereas men experienced a decrease in heart attack risk with no decrease in stroke risk.

Unfortunately, symptoms of heart disease in women are not classical. Often they feel no chest discomfort at all. About 50 percent of women experience "atypical" symptoms which may be a hot or burning sensation in the back, shoulders, arms or jaw, breathing difficulty or nausea, vomiting, extreme weakness and a sense of anxiety. It is all too likely to write-off these symptoms to mere musculoskeletal pain or gastrointestinal disturbances or anxiety which results in delayed diagnosis with subsequent increase in mortality after heart attack in the woman population.

Research indicates that behavioural changes on the part of women and reshaping of practice patterns by their health care providers may dramatically reduce the number of women disabled and killed by heart disease each year.