Once considered a disease of older men, cardiovascular disease is now affecting women in record numbers.
Cardiovascular disease is the major cause of death and disability among Canadian women. (The number of deaths from heart disease each year outnumbers those from breast cancer by over 10 to one.) Almost the same number of women die from heart disease as men, and two in three women have one or more of the major risk factors.
Forty percent of all Canadian women's deaths are due to heart disease or stroke. Many of these are deemed “unnecessary” - due in part to misdiagnosis or a lack of awareness by the affected woman that she was in fact experiencing a heart attack.
Heart Disease and Menopause
A woman’s risk of heart disease increases dramatically after menopause. This is due to waning levels of the hormone estrogen, which plays a protective role. (Natural estrogen helps to keep blood pressure low and helps prevent the deposition of fats in the arteries.)
Men under age 55 have a higher risk of heart disease than women in the same age group, but this anomaly quickly evens out when menopause is reached. After age 55, a woman’s risk of dying during the year following her first heart attack is 44 percent. (In men, the risk is 27 percent.) Estrogen is not believed to reduce the risk of stroke in women.
When menopause occurs naturally, the risk for heart disease develops slowly. The risk increases far more significantly when menopause results from a hysterectomy.
Heart Disease and Hormone Replacement
Since natural estrogen appears to protect a women against heart disease, researchers have traditionally believed that hormone replacement therapy (HRT) after menopause would help reduce risk of heart attack.
Recent research has indicated that HRT’s effect on the heart may not be as beneficial as initially thought. Women on HRT may actually have increased risk for coronary artery disease in the first year of use. While older studies looking at long-term use of hormone replacement indicated a 40 to 50 percent reduction in the risk of dying from heart disease, a recent randomized trial failed to show any protection from heart disease.
Scientists continue to investigate HRT’s effect on the heart. If you have any questions or concerns about your personal use of HRT, it is best to discuss them with your doctor.
Heat Disease and Women Under Age 55
Not all female victims of heart disease have reached menopause. Family doctors and hospital emergency rooms are seeing an increasing number of women under the age of 55 who are experiencing a heart attack.
Women under 55 are more than twice as likely to die of heart attacks than men in the same age group, partly due to misdiagnosis. (A woman’s symptoms are sometimes not as well-defined as a man’s and often dismissed as indigestion or a reaction to stress.) It is therefore important to learn and be able to recognize the signs of an impending heart attack.
Risk Factors
The following are risk factors for heart disease in women:
- Having diabetes. Diabetes increases your risk of cardiovascular death threefold, especially if you are aged 35 to 65.
- Menopause. You're at a higher-than-average risk if you are postmenopausal.
- Family history. If one or both parents or a sibling has had a heart attack or stroke, the higher your risk, especially if your mother was under 65 or your father was under 55 at the time.
- High blood pressure. If you have high blood pressure (above 140/90), you're more than three times at risk.
- Smoking. Nicotine reduces estrogen levels and puts you at four to five times greater risk of having heart disease than non-smokers. If you are over 35, smoke, and take oral contraceptives, you may have 10 times the risk of heart disease.
- Being overweight. According to a recent Harvard University study, even modest weight gains (about 11 pounds more than your weight at age 18), are associated with a significant increase in risk of heart disease. The larger your waist in proportion to your hips, the greater your risk.
- Being sedentary. Compared with active women, inactive women are twice as likely to die from heart disease or stroke.
- HDL level below 0.9 mmol/L. The lower your high density lipoproteins (HDL or “good” cholesterol), the higher your risk of heart disease.
Could You Be Having a Heart Attack?
Seventy percent of women experience similar symptoms during a heart attack as men: a sudden, crushing chest pain and shortness of breath. Other, less well-defined symptoms include:
- Mild chest pain or discomfort. Many heart attacks start slowly, with pain or discomfort in the centre of the chest.
- Uncomfortable pressure, squeezing, or sensation of fullness in the chest.
- Discomfort in the stomach, jaw, neck or back (a common symptom in women).
- Shortness of breath or cold sweat.
- Feeling of indigestion or nausea.
- Lightheadedness accompanying any of these symptoms.
Women often ignore the warning signs of a heart attack. You should seek immediate medical attention if you experience one or more of the above symptoms.
It is also recommended that you chew or swallow one adult (325 mg) ASA tablet or two 81mg tablets when the symptoms begin. Studies show that taking ASA as soon as a heart attack is suspected may reduce the risk of death or complications.