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Reviewed by Dr Soon Chao Yang
Women and Heart Disease
Introduction
Nature has conferred a cardiovascular protection on women to have lower risk of developing heart disease compared to men. The female hormone, Oestrogen has been widely credited for the cardiovascular benefits observed in women.
Even though for many years women were considered to be less at risk for cardiovascular disease than men, studies are increasingly revealing some data to the contrary.
CHD- A leading cause of death in women worldwide
Heart Disease is a leading cause of death in women worldwide. Cardiovascular diseases including heart attacks and strokes are responsible for the highest number of mortality among
While the overall death rates from Coronary Heart Disease in both genders are declining, there is sign of uptrend in younger women due to unhealthy lifestyles and nutritional intake.
In a survey conducted by the Singapore Heart Foundation in 2006, more than half of the 1136 women surveyed thought that cancer was a bigger health risk than heart disease and do not have adequate understanding of their risks.
Researches show that women’s cardiovascular disease risk increases sharply after menopause and gradually matches rates of men. Overall, while there is a lesser likelihood of CAD in women as compared to men, a positive diagnosis in a woman would render similar prognosis to a man.
Moreover, the symptoms of a heart attack in a woman may be manifested differently from men. Diagnosis and treatments are known to differ between the genders and it remains important for a woman to clearly identify her risks and seek appropriate prevention and therapy.
Differences in Diagnosis and Treatment
Many scientific studies show that women tend to be undertreated and do not get the same level of care. They are less likely to have the appropriate diagnostic tests and treatments when a diagnosis of heart disease is confirmed.
Diagnosis is more difficult in women as most women do not exhibit the same symptoms when experiencing a cardiac event as men. This is further complicated by the lower accuracy of certain non-invasive tests, such as the exercise electrocardiogram (ECG) test which tends to produce ‘false-positive’ results in women.
Clearly, there are variances when it comes to treatments. More men than women undergo coronary bypass surgery as women tend to have diffused forms of disease, making them unsuitable as targets for bypass. Also, as women are often diagnosed later, they are less willing to undergo CABG, resulting is less frequent referrals by their physicians.
Procedural outcomes for bypass surgery and coronary angioplasty has not yielded better outcomes for women as they tend to be of an older age and poorer prognosis. Also, the heart size of a woman tends to be smaller, making it more difficult to perform any procedures on the narrower arteries.
Women’s ‘Gender Protection’ and other risk factors
Overall, simply being female puts a woman at an advantage over a man in terms of heart health. Nevertheless, it may be prudent to be aware of factors that can affect one’s cardiovascular health.
Before menopause, a woman chance of developing CHD is lower than a man. This protection is thought to be conferred by the hormone oestrogen. Women also tend to have higher levels of HDL (good cholesterol) compared to men.
While a woman’s risk is still mediated by the composite of all other risk factors such as genetic makeup, high blood pressure, high blood cholesterol and sedentary lifestyles, some risk factors such as diabetes and smoking may even eradicate the advantage of being female altogether.
The greatest risk factor of all- smoking increases the risk of developing a heart attack by 2-6 times in a female smoker compared to a non-smoker. Promoting a dangerous distribution of body fat, smoking puts women who smoke at a higher risk of sudden cardiac death. The lethal combination of smoking and use of contraceptive pills may result in increase heart attack risk.
Preventing cardiovascular disease in women
Instead of assessing individual risk factors, the standard of preventive efforts is shifting towards the collective or global risks.
It is now possible to calculate a 10-year score for CHD risk in women with the Framingham Score Point Calculator which defines a woman’s risk at low, intermediate and high according to a prespecified set of criteria.
This risk stratification scoring system helps to determine the subsequent steps necessary to prevent any cardiovascular events. An online calculator is available at http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof.
Managing Heart Disease
Prevention and management of one’s risk factor(s) by taking positive steps are essential towards a healthier lifestyle. Here are some ways to keep heart disease at bay:
- Dietary modifications- by choosing diets low in saturated fats, sodium and cholesterol, you can improve the condition of your heart.
- Lower blood pressure
- Reduce cholesterol levels
- Incorporate physical activities
- Quit smoking
- Maintain a healthy weight
References
- Ford ES, Capewell S. Mortailty in CHD rising in young women. J Am Coll Cardiol 2007; 50:2128-2132
- Mayo Clinic ‘Heart Book’ 2nd Edition. Bernard J. Gersh. William Morrow. P 378-384.
- American Heart Association Scientific Position on Hormone Replacement Therapy and Cardiovascular Disease. Circulation. 2001;104:499-503
- Mosca L, Appel LJ, Benjamin EJ, Berra K, Chandra-Strobos N, Fabunmi RP, et al., for the American Heart Association. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation 2004; 109:672-93.
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