Women’s heart: Fact vs. Fiction

Guest column: Dr N Prabhudev

Let us not bother about fiction. Let us know the facts.

Guest Column: Dr. Prabhudev

Only about one-third of women know that heart disease is the leading cause of death for women.

Two-thirds of them think that cancer was their chief health risk. Cardiovascular disease kills nearly

half a million women each year – 240,000 women dying of heart attacks. This is twice the number of

all female cancer deaths combined. CVD kills more women -51.9% than men -48.1%. For years, heart

disease was studied, stereotyped, and considered a man’s disease.

Family history of heart disease is a stronger predictor of heart disease for women than it is for men.

Women with diabetes are roughly five times more likely to develop heart disease than women

without diabetics, while men are only two to three times more likely if they have diabetes. Women

are also more likely to die after their first heart attack than men.

The male model of heart disease gives the classic example of angina, or chest pain, around the

breastbone with the pain radiating to the throat or either arm as a signal of a heart attack. The early

signs of heart disease are exhibited very differently in women. women experience undiagnosed

warning signs up to two years before having a heart attack, with the five most-frequent symptoms

being fatigue, sleep disturbance, shortness of breath, indigestion, and anxiety. Women tend to

report a bewildering array of symptoms, which also include severe pain in the stomach, back, neck,

teeth, and ears; swelling in the legs; burning in the chest; nausea/vomiting; and depression.

Forty-five percent of women present their doctors with -no recognizable symptom or no symptom at

all of cardiovascular disease. Since doctors expect chest pain and numbness in the arms, women are

unaware that their symptoms may be different. Only 9% of women knew that nausea was a

symptom and 5% knew that fatigue was a symptom of a heart attack. Women tend to wait two or

more hours before seeking treatment. The treadmill stress test is only about 42% accurate in women

versus 90% accurate in men.

For decades, women and heart disease has largely been ignored by the medical profession, their

symptoms minimized, under-evaluated and under-treated. Many women with chest pain, trouble

breathing or palpitations, have been told they are anxious, hysterical, or having a panic attack. They

are often told that symptoms are in their head.

Women of childbearing age should be aware of their cholesterol, blood sugar, and blood pressure.

Preeclampsia has now been identified as a risk factor for heart disease later in life and should be a

warning flag for women to be screened later in life. A strong family history of heart disease (father

with heart attack under 55 mother under 65, should prompt earlier screening and more vigilant

management of other risk factors.

It is clear that pre-menopausal women have less cardiovascular disease than men. As women head

into menopause and estrogenic levels drop, a woman’s risk of heart disease increases and equals

that of men. Whether hormone replacement is harmful or protective – more research is needed.

There is emerging evidence that hormone-replacement therapy may benefit women in a certain age

window – 50 to 59 while it may be harmful to older women – 70 to79.

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