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Heart Disease Affects Men And Women Differently, Know Why?

There are differences in the presentation, occurrence, course, and treatment of several cardiovascular diseases between the genders. This change sometimes protects women and at other times enhances it the susceptibility of women to heart disease.

Women and Men differ only by a single chromosome - 46XX for women and 46XY for men. This single chromosome influences the physiological, physiological, behavioral characteristics of both genders. There are differences in the presentation, occurrence, course, and treatment of several cardiovascular diseases between the genders. This change sometimes protects women and at other times enhances it the susceptibility of women to heart disease.

STARTLING STATISTICS! ARE WOMEN REALLY AWARE?

Majority of women are afraid of Breast Cancer! Several female celebrities promote the prevention of breast cancer and some even get preventive surgery for it! However, you rarely hear of an actress promoting the prevention of heart attacks in women.

The fact is that the leading cause of death in women is Cardiovascular Disease (CVD). Cardiovascular diseases cause around one-third of all deaths. In fact, heart diseases kill more women than breast cancer, strokes, lung cancer, and chronic lung disease COMBINED!!!

Among heart diseases, Coronary Artery disease (including Angina and Heart Attacks) accounts for half the deaths.  In other words, coronary artery diseases cause death in one among every six women. Younger women, less than 65 years of age, carry a higher mortality presenting with coronary artery disease than men of the same age.

People have several myths about CVD and their own risk to develop it. It’s about time women face reality.

Table 1: Myths and Reality about Heart Diseases in Women

PERCEPTION

REALITY

BREAST CANCER IS THE REAL THREAT TO WOMEN; NOT HEART DISEASE

HEART DISEASE CAUSES DEATH IN 1 IN 3 WOMEN; PER YEAR, 1 IN 30 WOMEN DIE OF BREAST CANCER 

HEART DISEASE DOESN’T AFFECT YOUNG WOMEN BUT AFFECTS MEN AND OLD PEOPLE

AT ANY AGE, HEART DISEASES CAN AFFECT WOMEN 

IN CHILD BEARING AGES, WOMEN DO NOT DEVELOP HEART DISEASE 

RISK OF HEART DISEASE 20 FOLD IS INCREASED WHEN SMOKING AND ORAL CONTRACEPTIVE PILLS ARE TAKEN TOGETHER 

‘I HAVE NO SYMPTOMS. HOW CAN I HAVE A HEART DISEASE?’

60% OF WOMEN HAVE NO PREVIOUS SYMPTOMS, WHO DIE OF A HEART ATTACK 

THE INDICATION OF HEART DISEASE IS BY DEVELOPMENT OF SEVERE CHEST PAIN

LESS THAN HALF OF WOMEN WITH HEART ATTACKS PRESENT WITH CHEST PAIN 

BREATHLESSNESS, INDIGESTION, NAUSEA DOES NOT MEAN HEART DISEASE

HALF THE WOMEN WITH HEART ATTACKS HAVE BREATHLESSNESS, INDIGESTION, NAUSEA, SHOULDER PAIN, FATIGUE

THE WOMEN WHO ARE FIT, HEART DISEASES DO NOT AFFECT THEM

IF SHE HAS A FAMILY HISTORY OF HEART DISEASE, EVEN A HEALTHY WOMAN CAN BE PRONE TO HEART DISEASE 


WOMEN AND TRADITIONAL CORONARY ARTERY DISEASE 

RISK FACTORS:

The earlier presentation of coronary artery disease in men by 8-10 years is the major difference in men and women. 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.

Smoking

·Half of all heart attacks in women are attributed to smoking (Active / Passive)

·Smoking women are 4-6 times more likely to get a heart attack than non-smokers

·Women who Smoke and take Oral Contraceptive tablets (Birth control tablets) increase the risk of heart disease 30 fold.

Hypertension

  • About one-third of all Indian adults suffer from high blood pressure
  • Overall only 25% and 40% of people in rural and urban areas are aware of their blood pressure
  • Age, alcohol, smoking and chewing tobacco, body mass index, central obesity (defined as waist circumference >90 cm in men and >80 cm in women), consumption of low vegetables/fruits, high consumption of dietary fat and salt, and sedentary activity are the significant risk factors for hypertension

·Birth Control Pills also increase the incidence of hypertension

Diabetes Mellitus

  • Diabetes is prevalent in 6-19% of Indians
  • Cardiovascular diseases are twice as common in women with diabetes as compared to those without diabetes.

·Diabetes increases the risk of cardiovascular disease 3-7 fold in women compared to 2-3 times in men

Dyslipidemia

  • 47% of women older than 20 years of age have a total serum cholesterol level ≥200 mg/dL
  • 31.7% have an LDL-cholesterol level ≥130 mg/dL
  • After menopause, the Total cholesterol, LDL cholesterol and Triglycerides increase by 10%.  This contributes to the increase in cardiovascular disease post-menopause

Lack of Physical Exercise

  • 30-45 minutes of walking 5 times/week reduce the risk of a heart attack in females by 50%.
  • Regular exercise helps to control blood pressure and diabetes, increases HDL, decreases body fat and possibly reduces the risk of prostate, breast and uterine cancers.

Obesity

  • 80% of Indian women are overweight (BMI > 23 kg/m2) and 66% of women are Obese (BMI >25 kg/m2) (Figure 5)
  • Obesity is more prevalent in Indian women than in men, all over the country 
  • Higher the weight, higher is the risk of cardiovascular death.

Psychosocial and other Factors

  • Psychosocial factors such as depression, stress at work or home, financial stress, one or more life events, among others add an important risk for development of heart disease
  • Psychosocial factors are associated more strongly with an increased risk among women
  • Healthy lifestyle including regular exercise, diet - fruit and vegetable intake and modest alcohol consumption provided stronger protection among women than among men

UNFORTUNATE DIFFERENCES IN PRESENTATION AND TREATMENT OF WOMEN HAVING 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 describe them differently when they might be experiencing Milder Symptoms.
  • Women may experience more frequently Nonspecific Prodromal Symptoms, such as fatigue.
  • The presenting symptoms in the absence of chest pain were all more frequent among women than among men like Dyspnea, nausea and vomiting, indigestion, fatigue, sweating, and arm or shoulder pain.
  • As compared to men, women usually have a Delayed Presentation to the hospital.
  • Compared to men, women are more likely to be misdiagnosed.
  • Usually women tend to be older and with more co-morbidities like hypertension, diabetes, dyslipidemia and heart failure as compared to men.
  • The treatment of heart attacks is not gender specific and 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. 
  • Compared to men, women less frequently undergo Coronary angiography or angioplasty or bypass surgery.
  • As compared to men with heart attacks, all these factors lead to a higher cardiovascular mortality in women less than 65 years of age.

OTHER HEART DISEASES IN WOMEN

Several heart diseases, other than coronary artery disease, affect women more commonly than men. Rheumatic heart disease especially mitral valve stenosis, which is endemic in India, affects women in their childbearing age and has a significant impact on pregnancy.   Several other diseases like cardiomyopathies, congenital heart diseases, connective tissue disorders, cardiac rhythm disturbances, pulmonary hypertension, etc. affect women across all age groups.  
Pregnancy can also impose several changes in the circulatory system, which can lead to worsening of several heart diseases. Several drugs have to be changed or modified to accommodate the fetus. Diseases like peripartum cardiomyopathy and pregnancy-induced hypertension are specific to the pregnant status. These diseases can pose a threat to the life of the fetus as well as the mother. 

CONCLUSION:

Than any other diseases including cancer, heart diseases claim more lives of women. , Including a false sense of immunity to heart attacks, Indian women have several misconceptions regarding heart diseases.  It is important to create awareness among women of the fact that they can develop heart diseases including heart attacks at any age.   Women are exposed to several risk factors like diabetes, stress, high cholesterol, obesity, lack of exercise, smoking, high blood pressure, etc. in the same, if not higher frequency than men. The symptoms that women face, there are several variations. 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.  It is about time that Indians become fair to the fairer sex!

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.


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Dr. Nihar Mehta

The author is a Full-Time Consultant Cardiologist working at Jaslok Hospital and Research Centre since the last 6 years. I have received special training in Echocardiography and Interventional Cardiology as well as Cardiovascular Imaging.

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