CHENNAI: Gender has nothing to do with heart attack. Every year, heart attack, the single biggest cause of death across the world, claims women and men in nearly equal numbers. As heart disease symptoms in women often differ from those in men, they tend to be ignored. By learning to recognise these symptoms, women can reduce their risk of death from heart attack.
Women tend to have more atypical symptoms such as pain in the jaw or neck or throat, pain in the upper abdomen or back, nausea, vomiting, fatigue, excessive sweating, breathing difficulty, and giddiness.
These symptoms may be vague and not as obvious as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called coronary microvascular disease.
Since women don’t always recognise their symptoms as those of a heart attack, they tend to show up in emergency rooms after heart damage has occurred. Around 75-80 per cent of women find out that they have had a heart attack only weeks or months later. Recent studies indicate that heart attacks are generally more severe in women than in men. Women are 50 per cent more likely to die than men within a year of having a heart attack. The probability of women having a second attack within five years of the first is two times more than that of a man.
Diabetes, high blood pressure, high cholesterol, obesity, unhealthy diet and lack of physical exercise are traditional risk factors for heart attack. But more interestingly, recent research shows that the non-traditional risk factors such as depression, anxiety, stress at home, and low social support are much higher in women than in men. Because of this, the rate of heart attacks in younger women are on the rise and heart attacks occurring in pre-menopausal women, which was once a rare occurrence. Evidence suggests that heart disease may start in childhood, develop silently over time, and arrive without warning as a heart attack, often a deadly one. So one shouldn’t wait for symptoms to appear before taking proven steps to reduce risk.
Women also don’t seem to fare as well as men do after consuming clot-busting drugs or undergoing emergency angioplasty procedures, as a part of heart attack treatment. Women tend to have more complications after the treatment for heart attack. Recently published sub-group analysis from the landmark Tamilnadu- STEMI program showed that women in India are twice as likely to die from a heart attack compared to men. This pattern of risk continued even among women less than 45 years of age and persisted up to a year after heart attack. Hence, closing the knowledge gaps on heart attack prevention, clinical presentations and treatments for women should be public health priorities.
There are significant gender differences in heart disease risk and prevention. Research is only now beginning to uncover the biological, medical, and social bases of these differences. For example, diabetes increases the risk of heart disease in women more than it does in men. Although women usually develop heart disease later than men, diabetes expunges 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.
Similarly, women who smoke are more likely to have a heart attack than male smokers. Menstruating women have some protection from heart disease because of the cholesterol lowering effect of estrogen — the hormone produced by the ovaries. After menopause, the risk of heart disease increases and overtakes that of a man of the same age. Stress and depression affect women’s hearts more than men’s.
Depression makes it difficult to follow a healthy lifestyle. Inflammatory diseases like rheumatoid arthritis and lupus can increase the risk of heart disease in both men and women.
So, what can women do to reduce the risk? Women of all ages need to be aware of warning signs of heart disease. This needs to be addressed by educating women about the risks of getting cardiovascular diseases. This can help many adopt a healthy lifestyle and take preventative strategies before a heart attack were to occur.
Living a healthy lifestyle can help reduce the risk of heart disease. Exercise regularly with moderate intensity such as walking at a brisk pace, on most days of the week or at least for 150 minutes a week.
Maintain a healthy weight of BMI less than 25 and eat a heart-healthy diet. Avoid refined, chemical-filled, and processed food and eat fresh and organic food that is low in trans fats and salt. Avoid exposure to even secondhand smoke, which can damage the blood vessels.
Have regular health screening to detect heart disease early and avail treatment when necessary. For women who do have heart disease, cardiac rehabilitation can improve health and aid in recovery.
The writer is a senior interventional cardiologist, Institute of cardiovascular Diseases, Madras Medical Mission, Chennai
Numbers that alert
- Around 75-80 per cent of women find out that they have had a heart attack only weeks or months later.
- Women are 50 per cent more likely to die than men within a year of having a heart attack.
- The probability of women having a second heart attack within five years of the first is two times more than that of a man.
- Research shows that the non-traditional risk factors such as depression, anxiety, stress at home, and low social support are much higher in women than in men.