Shilpa Kshatriya, MD
Heart disease in women seems to beat to a different tune. Over the years with advances in medicine less men are dying from heart disease but women seem to lag behind. Now, more women than men are dying from heart disease.
How are we different?
Women suffer from heart attacks 10 years later than men on average because of the initial protective effect of estrogen. However, smoking and having a family history of heart disease can cause heart disease to develop at a younger age, even in the 30’s!
Symptoms may be different. In fact, women are more likely to have a heart attack without chest pain. Common symptoms of a heart attack include ‘crushing’ chest pain going down the left arm or radiating to the jaw, sometimes associated with nausea, light-headedness or sweating. Women are more likely to have other warning signs, such as shortness of breath, nausea, indigestion, heart burn, poor appetite, and stomach pain.
Heart disease comes in a different package in women. There are anatomical and physiological differences between the sexes.. Women can have heart attacks due to ‘blockages’ in their coronary arteries (vessels which supply the heart). However, one-third of women will have chest pain or ANGINA despite having no ‘blockages’. Their chest pain can be due to problems with the cells lining the arterial vessel wall (‘endothelium’). Up until recently, these women were told that their problem was in their “head and not in their heart”.
Women have more risk factors for heart disease than men and are also less likely to have these risk factors controlled. Risk factors include smoking, poor diet, physical inactivity, family history, high blood pressure, abnormal cholesterol, overweight or obesity. Women smokers are more likely to develop heart disease than their male counterparts (25% higher risk) and diabetic women also have a disproportionately higher risk than men. If you have any of these risk factors you are at risk for heart disease.
In addition, there are some female-specific risk factors. Menopause increases your risk of heart disease 2 to 3 times. Good cholesterol (HDL) starts declining and bad cholesterol starts to increase (LDL). Having a history of pregnancy induced hypertension or pre-eclampsia , gestational diabetes, and polycystic ovarian syndrome increase your risk of heart disease. Women with a history of these medical problems should be monitored and their risk factors controlled. Autoimmune diseases like lupus (SLE) are more common in women and increase the risk of heart attacks; women with these disorders should be screened for heart disease.
Stress tests may be less accurate in women due to smaller coronary vessels, hormonal status and other factors. Your doctor may order a stress test combined with imaging to improve the accuracy.
Unfortunately, stress does cause heart disease and women are more susceptible to stress-related heart disease than men.
What can women do to avoid heart disease?
Know your risk factors. Ask your doctor if you are at risk for heart disease.
Know your cholesterol numbers –both LDL (bad ) and HDL(good) cholesterol are important
Keep an eye on your blood pressure (goal should be less than 140/90 mmHg)
Know your family history.
Stop smoking.
Know the symptoms of a heart attack.
Exercise regularly and follow a heart-healthy diet.
