Dr. Nihar Mehta
Women and Men are different only by a single chromosome - 46XX for women and 46XY for men. This single chromosome influences the physiological, physiological, behavioural characteristics of both genders. There are differences in the occurrence, presentation, course and treatment of several cardiovascular diseases between the genders. This single change sometimes protects women and at other times enhances the susceptibility of women to heart disease.
STARTLING STATISTICS! ARE WOMEN REALLY AWARE?
Majority of women are afraid of Breast Cancer! You hear several female celebrities propagating the early diagnosis of breast cancer. Some even get preventive surgery for it! However, you rarely hear of an actress promoting prevention of heart attacks in women…
The fact is that the leading cause of death in women is Cardiovascular Disease (CVD). One third of all deaths in women are due to cardiovascular diseases.
Among heart diseases, Coronary Artery disease (including Angina and Heart Attacks) accounts for half the deaths. In other words, one in every six women dies due to coronary artery disease.
There are several Myths that women have about CVD and their own risk to develop it. It’s about time women face the reality…
- Perception 1: Breast cancer is the real threat to women; not heart disease
- Reality 1: 1 in 3 women die of heart disease; 1 in 30 women die of breast cancer per year
- Perception 2: Heart disease affect men and old people; not young women
- Reality 2: Heart diseases can affect women at any age
- Perception 3: Women do not develop heart disease in child bearing ages
- Reality 3: Smoking and oral contraceptive pills taken together increase risk of heart disease 20 fold.
- Perception 4: ‘I have no symptoms…how can i have a heart disease?’
- Reality 4: 60% of women who die of a heart attack have no previous symptoms
- Perception 5: ‘Heart disease is indicated by development of severe chest pain
- Reality 5: Less than half of women with heart attacks present with chest pain
- Perception 6: ‘Breathlessness, nausea, indigestion does not mean heart disease
- Reality 6: Half the women with heart attacks have breathlessness, nausea, indigestion, shoulder pain, fatigue
- Perception 7: ‘Heart diseases do not affect women who are fit
- Reality 7: Even a healthy woman can be prone to heart disease if she has a family history of heart disease.
WOMEN AND CORONARY ARTERY DISEASE RISK FACTORS:
Non Modifiable Risk Factors:
- Family History
Modifiable Risk Factors:
- Lack of Physical Activity
- Diet (Lacking in Fruits and Vegetables)
- Diabetes Mellitus
- Psychosocial Factors
The major difference in men and women is the earlier presentation of coronary artery disease in men by 8-10 years. However, women catch up post-menopause. This premenopausal protection is afforded by estrogen in women. Nevertheless, hormonal replacement therapy with estrogen post-menopause does not prevent cardiovascular disease.
UNFORTUNATE DIFFERENCES IN PRESENTATION AND TREATMENT OF WOMEN WITH CORONARY ARTERY DISEASE
- Typical Symptoms commonly associated with Myocardial infarction or a heart attack in both sexes include chest pain, discomfort, pressure, or squeezing; pain radiating to the neck, shoulder, back, arms, or jaw.
- Atypical symptoms include palpitations; dyspnea; heartburn, nausea, vomiting, epigastric pain, diaphoresis; and dizziness.
- Women may experience Milder Symptoms and often describe them differently
- Women may more frequently experience Nonspecific Prodromal Symptoms, such as fatigue.
- Dyspnea, nausea and vomiting, indigestion, fatigue, sweating, and arm or shoulder pain as presenting symptoms in the absence of chest pain were all more frequent among women than among men
- Women usually have a Delayed Presentation to the hospital compared to men
- Women are more likely to be misdiagnosed than men
- Usually women tend to be older and with more co-morbidities like hypertension, diabetes, dyslipidemia and heart failure.
- The treatment of heart attacks is not gender specific. The guidelines do not offer different treatment based on sex.
- Women are less likely to receive standard treatment like aspirin, cholesterol reducing medications (statins) due to confusion in the diagnosis.
- Women less frequently undergo Coronary angiography or angioplasty or bypass surgery compared to men
- All these factors lead to a higher cardiovascular mortality in women less than 65 years of age, as compared to men with heart attacks.
Heart diseases claim more lives of women than any other disease including cancer. Indian women have several misconceptions regarding heart diseases, including a false sense of immunity to heart attacks. It is important that women are made aware of the fact that they can develop heart diseases including heart attacks at any age. Women are exposed to several risk factors like high blood pressure, diabetes, high cholesterol, obesity, lack of exercise, smoking, stress, etc. in the same, if not higher frequency that men. There are several variations in the symptoms that women experience. Often women have delayed presentations, are misdiagnosed and treated sub-optimally. It is essential that women and health care providers are educated regarding these differences.
1. Lloyd-Jones D, Adams R, Carnethon M, et al: Heart disease and stroke statistics—2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119:e21
2. Newby LK, Douglas PS. Cardiovascular disease in women. Braunwald’s Heart Disease. A text book of Cardiovascular medicine. 9th Edition. Editors: Bonow, Mann, Zipes, Libby. Publishers: Elsevier Saunders, Philipdelphia.