Heart disease in women

Beating heart disease in women For decades, more women have died of coronary heart disease than other non-communicable illnesses. But most women still perceive coronary heart disease as an illness affecting mostly men. The fact that it is a No. 1 killer among women still comes as a surprise. The fear of dying from breast cancer is more on women's minds. But the facts on coronary heart disease and women in the country are clear - the deaths from heart disease are 1.5 times higher than that from cancer, according to the Health Ministry. From 1990 to 2005, heart disease among Malaysian women rose by 135 per cent. Global statistics are just as grim. Each year, over 8.6 million women die of heart disease and stroke. This is more than deaths from cancer, tuberculosis, HIV/AIDS and malaria combined. In Malaysia, one in four women die of heart attack and stroke. Prince Court Medical Centre consultant interventional cardiologist Dr Shanker V. Moorthy says: "While generally women are protected to a certain extent from coronary heart disease until menopause, there are cases of much younger women, even in their 30s and 40s suffering from heart attacks. Bad lifestyle habits have led to an increasing number of coronary heart disease risk factors." The worrying part is that when women have a heart attack, they have a worse prognosis compared to men of the same age. "Women with coronary heart disease are generally 10 years older than men at the time of presentation and carry a greater burden of risk factors. Women who are at risk are mainly those who smoke, have a strong family history, are diabetic, have high cholesterol, high blood pressure, are obese and lead a sedentary lifestyle. The greater the number of risk factors, the higher their overall risk," he says. HIGHER RISK Diabetics, especially, have much higher risk of heart attack. According to Dr Shanker, the risk of a woman who has diabetes is as high as someone who has already suffered a heart attack. Known as diabetic cardiomyopathy, the condition damages the structure and function of the heart. This disease can lead to heart failure and arrhythmia, even in people who have diabetes but don't have coronary heart disease. Compared to people who are not diabetics, they may develop heart disease at a younger age and have more severe heart disease. The first presentation of coronary heart disease may be chest pain, heart attack, heart failure or sudden cardiac death. Women may not identify their initial symptoms as an expression of heart disease and therefore may not seek medical advice promptly even in an emergency. Furthermore, doctors may not evaluate symptoms that represent coronary heart disease as early in women as they do in men. Although the mortality rate is decreasing mainly due to better treatment, this condition continues to be under-diagnosed in women. Dr Shanker says one of the reasons is that women tend to feel different symptoms compared to men. The typical symptoms of chest pain (angina) are less common than in men. Women rate their chest pain as more intense, use different terms to describe their pain (more often sharp and burning), have more symptoms unrelated to pain and more frequently have pain and other sensations in the neck and throat. Upper abdominal discomfort, shortness of breath on exertion, fatigue or difficulty in sleeping may be misdiagnosed as other medical conditions. "In the event of a heart attack, the faster that the woman and medical professionals realise the symptoms, the quicker the appropriate tests can be done and the faster the treatment can be initiated. This will minimise damage to the heart muscle and translates into better outcome for the patient." KNOW YOUR NUMBERS Dr Shanker says a woman should also know her "existing and ideal numbers". This means that women should be aware of their body weight, blood pressure, cholesterol and blood sugar levels. These are the risk factors that can be controlled with a change in lifestyle. Women who are at risk should go for regular screening from the age of 50. Those with multiple risk factors should go for screening earlier. "Early detection can save lives." REDUCE RISK FACTORS WOMEN should take the following precautions to reduce the risk of heart disease: Quit smoking: Smokers have more than twice the risk of heart attack as nonsmokers. Smoking is also the most preventable risk factor. If you smoke, quit. Better yet, never start smoking. Non-smokers who are exposed to constant smoke (such as living with a spouse who smokes) also have an increased risk. Improve cholesterol levels: The risk of heart disease increases as your total amount of cholesterol increases. A diet low in cholesterol and saturated and transfat will help lower cholesterol levels and reduce your risk of heart disease. Medications are often needed to reach cholesterol goals. Control high blood pressure: Like cholesterol, blood pressure interpretation and treatment should be individualised, taking into account your entire risk profile. Control blood pressure through diet, exercise, weight management, and if needed, medication. Control diabetes: Diabetes can contribute to significant heart damage, including heart attack and death. Control diabetes through a healthy diet, exercise, maintaining a healthy weight and taking medication as prescribed by your doctor. Get active: Most people should exercise 30 minutes a day, at moderate intensity, on most days. More vigorous activities are associated with more benefits. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day. Consult your doctor before starting any exercise programme. Eat right: A heart-healthy diet is low in salt, saturated fat, transfat, cholesterol and refined sugars. Try to increase intake of foods rich in vitamins and other nutrients, especially antioxidants, which have been proven to lower risk of heart disease. Also eat plant-based foods such as fruit and vegetables, nuts and whole grains. Achieve and maintain a healthy weight: Excess weight puts significant strain on your heart and worsens several other heart disease risk factors such as diabetes, high blood pressure and high cholesterol and triglycerides. Research shows that obesity itself increases heart disease risk. By eating right and exercising, you can lose weight and reduce risk of heart disease. Manage stress: Poorly controlled stress and anger can lead to heart attacks and strokes. Learn to manage stress by practising relaxation techniques, learning to manage time, setting realistic goals and trying some new techniques such as guided imagery, massage or tai qi. Dangerous myths Most women die from cancer. Each year globally, women's deaths from heart disease and stroke account for more than deaths from cancer, tuberculosis, HIV/AIDS and malaria combined. Coronary heart disease is a man's problem. More and more women are diagnosed with this disease, especially with the stress level of modern living. Only older women have coronary heart disease. Women in their 30s and 40s are suffering from this condition. Women and men with coronary heart disease get the same care. Women and men present different symptoms of the same disease and for women, their cases are often under or misdiagnosed due to this. If coronary heart disease is not in your family, it is not your problem. If you do not reduce the risk factors like quitting smoking, eating right and exercising, you will still be at risk of coronary heart disease. You cannot do anything to prevent coronary heart disease. You can reduce the risk factors, recognise symptoms and get emergency help when you feel something is wrong. It is better to go to the hospital and find out you did not suffer a heart attack rather than risk getting proper attention and medical care. Diabetes and the heart THE risk of a diabetic woman suffering a heart attack is as high as someone who has already suffered a heart attack. Publication: NST Date of publication: Sep 25, 2012