Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

Heart health in women

Why are heart diseases common in women?

  With the unprecedented increase in the incidence of heart diseases  in female population globally, heart health in women needs a critical evaluation in relation to risk factors and triggers. Over 60 million women (44%) in the United States are living with some form of heart diseases.

  Heart disease is one of the major causes of death for women in the United States and can affect women at any age. In 2021, it was responsible for the deaths of 310,661 women—or about 1 in every 5 female deaths. Approximately 2.8 million women have been diagnosed with heart diseases in the UK.
     A woman’s heart and blood vessels are smaller, and the muscular walls of women’s hearts are thinner when compared with that of men. Women are more likely to have heart disease in the smaller arteries of their heart with intense symptoms of chest discomfort. 

 Types of heart diseases in women

Myocardial infarction or heart attack

Factors such as age, lifestyle habits, and other medical conditions enhance the risk of a heart attack. Symptoms of a heart attack include chest and upper body pain, shortness of breath, dizziness, sweating, and nausea. Women often experience different symptoms of  heart attack.

Coronary artery disease [CAD]

 CAD is the leading cause of death for women and it is caused by plaque in the walls of the arteries that supply blood to the heart and whole body. About 80% of women age 40 to 60 have one or more risk factors for coronary heart disease. Menopausal women are at high risk due to the associated hormonal dip.

After menopause estrogen hormone declines and it increases the risk for coronary artery disease. Menopausal hormone therapy further increases the risk for heart diseases. Women who reach early menopause are more likely to develop heart disease than women of the same age.
Angina, or chest pain and discomfort, is the most common symptom of CAD. Angina may occur when plaque formation inside arteries reaches a high level narrowing them. Narrowed arteries can cause chest pain blocking blood flow to your heart muscle and the rest of your body.

 Arrhythmia

This abnormalities are associated with the rhythm of heart beat. The heart beats too slowly, too fast, or in an irregular way. A common example for  arrythmia is atrial fibrillation.

Heart failure:

Heart failure is a condition when heart is too weak to pump enough blood  and supply to other parts of the body. This condition of reduction in pumping of heart will become serious overtime.

Symptoms of Heart Disease in Women

The symptoms of heart diseases in women vary according to the nature of disease. Symptoms of heart attack include:
·   Chest pain or discomfort (angina)
·   Weakness
·   light-headedness or dizziness
·   nausea
·   a cold sweat
·   Pain or discomfort in the arms or shoulder
·   Shortness of breath

  Angina or chest pain may be usually felt as a dull or heavy chest discomfort or pain. Pain may radiate or spread to the neck, jaw, or throat. In some women pain is felt in the upper abdomen or back. The symptoms may appear during resting or active phase.
In some women nausea and vomiting may occur along with exhausted feeling of weakness.

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What factors enhance the risk for heart diseases?

Apart from menopause and associated estrogen hormonal decline ,various other factors may increase the risk for heart diseases.

·  Anaemia is an important health problem in women particularly during pregnancy which increases the risk for heart diseases overtime if left untreated.
·  Early menopause (before age 40) in women enhances the risk due to estrogen decline.

·  Endometriosis in women also has some link with increased heart disease risk.

·  High blood pressure after age 65 also further enhances the risk.

·  Certain pregnancy related problems such as gestational diabetes, preeclampsia, eclampsia [high blood pressure during pregnancy), and premature child birth etc. increase the risk.

·   Birth control pills  are also associated with increased heart disease risk. The estrogen component in combined oral contraceptives significantly increases the risk of venous  and arterial thrombosis (2–7-fold) irrespective of the type of progestin used although the risk is small in absolute numbers. Therefore, combined oral contraceptives are not recommended for preventing pregnancy or they are even contraindicated in women with cardiac disease,  ischaemic heart disease or hypertension.

·  Some inflammatory and autoimmune diseases also are associated with heart diseases.

·  Lack of physical activity , sedentary life style enhances the risk.

·   Stress, marital stress, anxiety, depression, or low social support

·   Metabolic syndrome- obesity and high cholesterol, high blood pressure increase the risk for heart attack.
·   Overweight and obesity.

·   Diabetes increases the heart disease risk as diabetes increases tendency to clot formation in blood vessels.

·   Low levels of HDL cholesterol. HDL cholesterol has protective role in heart diseases. Lowered levels of HDL enhance the risk for heart diseases.
·   Mild to moderate high blood pressure   increases the risk for heart diseases.
·   Smoking also increases the risk for clot formation in blood vessels and leads to heart diseases.

 Symptom variations in women

   Women are more likely than men to have angina or chest pain or angina while they are resting. In women chest pain mostly develop during routine daily activities rather than during exercise. Chest pain may last longer and be more painful than other types of angina in small vessel obstruction.
The location and type of pain also may vary. Pain symptoms are different for each woman. Women may feel chest pain often as crushing, or they say it feels like pressure, squeezing, or tightness of chest. Pain may radiate towards the neck and throat.
Mental stress is a common trigger of angina  in women than in men.
Other symptoms common for women include nausea, vomiting, shortness of breath, abdominal pain, sleep problems, tiredness, and lack of energy.

Diagnosis

Tests and procedures for diagnosing heart diseases are similar for women and men, but women may experience delays in diagnosis or treatment.
Women tend to present less frequently with exertional symptoms of chest pain; It can happen during periods of rest also. However in progressing cases of heart diseases both men and women present with chest pain.

Women may experience some additional vague symptoms such as fatigue or weakness and sleep disturbance in heart diseases, particularly in angina.

Menopause and post-menopausal phase in women’s lives are associated with a worsening coronary heart disease risk.
The menopause is associated with an increase in body weight, alteration in fat distribution, obesity and visceral fat deposition, with an associated increase in other heart disease risk  enhancing factors such as diabetes mellitus.
In women  above the age of 75,  systolic hypertension is 14 % more prevalent than in men and it has impact on heart as it may lead to left ventricular hypertrophy, diastolic heart failure and cerebrovascular disease.

Stress cardiomyopathy is another problem in women which is triggered by intense, unexpected emotional or physical stress and is characterized by temporary systolic dysfunction with ballooning of the left ventricle. The syndrome predominantly affects postmenopausal women. It may resemble myocardial infarction on ECG and cardiac troponin levels. However, angiography does not reveal obstructive coronary disease.
It seems that genes are connected with stress cardiomyopathy, as they are identified in family. But around 56 % of sufferers had a psychiatric or neurological disorder associated with stress cardiomyopathy.

The exercise ECG is of limited use in the evaluation of chest pain in women, owing to lower diagnostic accuracy for coronary artery disease compared to men.
Pharmacological stress testing is an accurate diagnostic technique and is preferred for diagnosing CAD in females with lower exercise capacity.
Computed tomography coronary angiography has similar diagnostic accuracy in detecting ≥50 % and ≥70 % coronary stenosis in women.
Women presenting with ST-segment elevation myocardial infarction have worse outcomes compared to men, but in those presenting with non-ST-segment elevation myocardial infarction no sex-dependent differences in outcome were demonstrated [9].

American Heart Association's [ AHA] recommendations for the Prevention of Cardiovascular Disease Women

  The 2011 American Heart Association guideline for the prevention of cardiovascular disease in women highlights the importance of lifestyle modification, smoking cessation and diet in order to reduce the morbidity and mortality related to CVD.

·    Lifestyle Changes        

    The recommendations include :

Eat oily fish at least twice a week ,limit saturated fat intake, take Antioxidant supplements in high risk groups, e.g. vitamins C and E, should not be used for primary/secondary prevention of cardiovascular disease.

It is very important to improve the heart health of women in various phases of life including high risk periods such as pregnancy and menopause to prevent the rise in female mortality rate  from heart diseases in the population. Therefore it is recommended to follow all the  directions by AHA  and stay healthy and fit.

Reference

1.    https://www.cdc.gov/heartdisease/women.htm
2.    https://www.nhlbi.nih.gov/health/coronary-heart-disease/women
3.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206467/
4.    https://pubmed.ncbi.nlm.nih.gov/24352519/
5.    https://pubmed.ncbi.nlm.nih.gov/16458170/
6.    https://pubmed.ncbi.nlm.nih.gov/14970104/
7.    https://pubmed.ncbi.nlm.nih.gov/11794147/
8.    https://pubmed.ncbi.nlm.nih.gov/26332547/
9.    https://pubmed.ncbi.nlm.nih.gov/2873379/
10.  https://www.nhlbi.nih.gov/health/heart-attack#:~:text=A%20heart%20attack%2C%20also%20known,Heart%20attacks%20are%20very%20common.