Women and heart disease


Everyone knows the seriousness of breast cancer and the need for women to constantly check their breasts for lumps and have regular mammograms when they reach a certain age.

What is not widely known is that heart disease kills six times more women than breast cancer.

Although one in three men and one in four women suffer from heart disease in South Africa, there's very little awareness around this. Another factor that adds to this statistic is that women also show the biggest increase in obesity, which heightens the risk.

What's more, women present with different signs and symptoms - a situation which often leads to late diagnosis of the disease.

How is heart disease different in women?

  • Chest pain is often the first symptom that will alert you to problems. But women and their doctors often misinterpret this symptom. Women are far more likely to land up with a diagnosis of heartburn or gastro-oesophageal reflux disease (GORD), or even stress or depression. In men, the presence of chest pain will accurately predict CAD more than 90% of the time. In women, however, this predictive value falls to around 70%.
  • The risk factors for CAD are similar in women, but there are differences. The ways in which cigarette smoking, hypertension, diabetes, family history and obesity affect women are subtly different from the ways in which they affect men.
    • Cigarette smoking – possibly the most important risk factor for CAD – has declined in men, but increased in young women. Smoking as few as one to four cigarettes a day seems to increase the risk of death from CAD in women.
    • Lipid levels are generally lower in women than in men between the ages of 20 to 55. But after the age of 55, women’s cholesterol levels rapidly rise and may be higher than those of men of the same age. The levels of HDL cholesterol (the good form of cholesterol) are higher in women than in men until after the menopause. After menopause, increased total cholesterol, decreased HDL cholesterol and triglycerides are as important as risk factors for CAD as they are in men.
    • After the age of fifty, women are twice as likely to suffer from high blood pressure as men of the same age. Because women live longer than men, there are many more hypertensive women than men. In spite of this, all major studies on the effects of hypertension on CAD have been carried out on men. There is no reason to believe that hypertension is not a risk factor for CAD in women, so look after you blood pressure!
  • Diabetic women are more likely to develop CAD than men with diabetes. This is probably because diabetes is associated with high blood pressure, obesity and high blood lipids - factors which are more common in elderly women than in men.
  • Family history is a particularly important factor in women – more so than in men. This is particularly the case in young women.
  • Obesity is a difficult risk factor to evaluate in women – other than the fact that it predisposes to type 2 diabetes. Women tend to accumulate fat on their hips and thighs, where it doesn’t carry the same risks as the abdominal accumulation of fat that is more common in men. However, after the menopause, women often experience a shift in fat distribution, with more landing up around the tummy. This may lead to a higher risk of CAD.

What about HRT and heart disease?

Women with heart disease should not use hormone replacement therapy (HRT) to prevent the risk of further heart disease. Such use increases the risk of blood clots. It also increases the risk of heart attack in the first year of therapy.

Talk to your health-care provider about lifestyle changes and other action steps that have proven to be safe and effective in helping to prevent heart disease.

Ways to prevent heart disease and stroke include lifestyle changes and such drugs as cholesterol-lowering statins and blood-pressure medications. Lifestyle changes include: not smoking, maintaining a healthy weight, being physically active and managing diabetes.

What does all this mean for me?

If you have a strong family history of CAD, you need to take prevention particularly seriously. About 20% of women with one or more relatives who had CAD before the age of 60 have a 10-year risk of CAD of about seven per 100. A 50-year-old woman with a brother or sister with CAD faces a 10-year risk of more like 15 per 100.

Another factor to take into account is the fact that because women tend to show signs of heart disease later in life, it is often more advanced when it is first diagnosed than it is in men. Women also have smaller blood vessels and so suffer more from the effects of plaque. The bottom line here is that women suffer disproportionately more deaths when they have a heart attack than men do.

Having said all this, for most women, however, being female is worth about 10 to 15 years of life without significant CAD. This is the same as being a non-smoker, not having diabetes and not having a strong family history. You can see this as a kind of grace period – more time to alter your lifestyle if you need to, to reduce any risk factors you may already have.

Don’t see this as an excuse not to look after yourself and take regular exercise though. CAD is still the leading cause of death in women in Western countries and South Africa is no different.

Press releases compiled by the Heart and Stroke Foundation of South Africa
Document compiled by the US National Institutes of Health ("Facts About Menopausal Hormone Therapy")

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