Heart disease in women is not given the importance it needs.
It is a leading killer of women, affecting one in five, according to the US Centers for Disease Control and Prevention. A considerably sobering statistic, and what’s even more worrying is that only half the women realise that heart disease is their biggest health battle.
Considering women navigate a far more complex hormonal landscape than men, they face different challenges in terms of their heart health.
Why women face different challenges
While hearts are universal, there’s a key difference between men’s and women’s. There are variations in the size and structure of women’s hearts, as compared to men, explain experts.
“Women generally have smaller hearts and blood vessels, as compared to men,” says Reshmi Goswami, a Dubai-based physician. The size difference isn’t all that trivial as it seems; it carries a hidden danger. “There are studies that show that women have a higher likelihood of developing heart disease in the smaller arteries of their heart,” she says.
This poses a dangerous risk, as it becomes far more difficult to diagnose. The smaller passageways are trickier to diagnose blockages in, leading to missed diagnoses and delayed treatment. This translates to a higher risk for women; a risk that often goes undetected.
Apart from the structure itself, women experience a wide range of hormonal fluctuations throughout their lives.
The monthly cycle and pregnancy
During menstruation, estrogen dips, while the stress hormones rise. This can lead to a faster heart rate, putting extra strain on the heart. Depression can further compound this stress, explains Harjit Bahia, founder and CEO of UK-based Longevity, and the co-founder of Dubai-based ZOI-ME.
There is a wide range of variables in the case for women, say Bahia and Goswami.There are medical conditions that could even emerge during pregnancy, which influence the health of the heart during the pregnancy and later in life. This could include common conditions such as gestational diabetes and high blood pressure.
The decline of estrogen after menopause
As Brajesh Mittal, Consultant Interventional Cardiology, Al Safa – Medcare Hospital explains, after menopause, women gain more visceral fat. "Their arteries grow thicker and becomes rigid, rendering them more susceptible to diseases. Menopause-related hot flashes and night sweats have been linked to an increased risk of high blood pressure and other cardiovascular risks," he explains. Women who go through the natural menopause later in life are less likely to develop cardiovascular illnesses, as he says. Poor cardiovascular health throughout the reproductive years, and possibly genetics are all factors that may contribute to an early onset of menopause.
The arteries grow thicker and becomes rigid, rendering them more susceptible to diseases. Menopause-related hot flashes and night sweats have been linked to an increased risk of high blood pressure and other cardiovascular risks...
A lot comes down to estrogen, which acts as a cardiovascular guard for women. It declines as they age, explains Bahia. The hormone plays a key role in navigating heart health for women, as it helps the tissues throughout the body stay supple and flexible. It contributes to increasing blood flow and keep blood pressure under control. Prior to menopause, the estrogen increases the HDL (good) cholesterol and decreases the LDL or bad cholesterol.
However, the levels start decreasing after the age of 36, says Bahia. As the estrogen levels lower, the blood vessel walls become stiffer and more prone to inflammation. This accelerates plaque buildup and increases the risk of blockages that can trigger heart attacks. Large scale studies like the US-based Study of Women’s Health Across the Nation (SWAN) show that during the menopause transition there are significant changes to cardiovascular health. While the HDL decreases and LDL increases, blood lipids or fats increase, too. There’s also a protein in blood plasma called fibrinogen, which is linked with heart disease and stroke, increases, says the study.
During menstruation, estrogen dips, while the stress hormones rise. This can lead to a faster heart rate, putting extra strain on the heart. Depression can further compound this stress...
Moreover, during the reproductive years, women who gain weight tend to collect fat around the hips and thighs. This does not pose a risk to heart health, at the time. However, after menopause, more fat is distributed in the abdomen and around the heart, and this visceral fat is linked with CVD or cardiovascular disease explains Goswami.
Depression
The hormonal fluctuations multiply manifold, when a woman suffers from depression, as this adds another layer of stress on the heart, says Bahia. When a person is under chronic stress, there can be widespread inflammation in the body. This can damage blood vessels and contribute to further plaque build-up in the arteries, which increases the risk of blockages and heart attacks.
What are the symptoms of a heart attack in women?
The classic symptom that everyone knows is shooting pain up and down in your left arm. However, for women it’s a lot trickier to diagnose, says Goswami.
In the case of women, they have rather ‘non-classic’ symptoms, which include fatigue, nausea, and abdominal discomfort. “They have pain along the back as well as the jaw. These are all linked to cardiovascular trouble in women; the warning signs of a heart attack,” she says. In fact, there have been some cases where women have reported fatigue and disturbed sleep patterns, sometimes as much as a month before a heart attack.
There are many subtle symptoms, warns Goswami. You just need to pay close attention to your body and don’t wait to seek help, she says.
The kinds of heart diseases: CAD and heart failure
The most prevalent type of heart disease—and the main cause of mortality for women—is caused by plaque in the walls of the arteries that transport blood to your heart and other parts of your body, which is typically diagnosed in women over 50, according to Mittal.
As Goswami explains, heart diseases are an umbrella term that encompasses many cardio-vascular conditions. The common culprit is Coronary Heart Disease (CAD), which blocks or narrows the heart arteries with plaques that are built from cholesterol deposits. This contributes to heart attacks and strokes. The leading cause behind CAD is due to unhealthy lifestyle habits, that include unmitigated stress levels, poor maintenance of weight, and high cholesterol, she says.
While CAD is harmful enough, there are other kind of heart diseases, that include heart rhythm abnormalities. In the case of atrial fibrillation, the heart beats irregularly, which results in blood clots, complications like stroke and heart failure. Heart failure is considered a different kind of disease altogether; it is a consequence of a damaged and weakened heart, says Goswami. There are a wide range of reasons behind heart failures, including high blood pressure, viral or bacterial infections.
How can women protect their cardiac health?
For starters, be aware, explains Goswami. You need to be able to manage existing medical conditions that increase the risk of heart disease, and that includes blood pressure. You also need to keep a track on diabetes as well as high cholesterol. Another risk factor is diabetes, she says. Diabetes elevates the risk of heart disease in women more than it does in men, perhaps because women with diabetes more often have added risk factors, such as obesity, hypertension, and high cholesterol.
Here’s what you can do:
Be more active: Make sure that you get at least 30 minutes of moderate exercise, such as walking. Introduce small changes into your life, like taking the stairs, instead of the elevator.
Eat a balanced diet: Make sure that your diet includes whole grains, a variety of fruits and vegetables, nuts, poly- and monounsaturated fats, fatty fish (such as wild salmon), and limited intake of trans fats.
Reduce stress and treat depression: Find ways to manage your stress levels. Look for relaxation strategies, and make sure you get enough sleep.
