Rising Heart Diseases among Women
A 42 year old female, working in a Government office, had to travel everyday by train from her residence at Kalyan to Nariman point. She started noticing that she became progressively breathless while taking the flight of stairs on her way to board the train. She was lean, 55kg and had no risk factors. She underwent a routine health checkup at Fortis, Kalyan and to her disbelief her stress test turned out to be strongly positive. It was a further shock to the family after a Coronary Angiogram revealed that she had critical Double Vessel Disease. Subsequently, a Two Vessel Angioplasty was performed on her and now she is clinically better and her effort tolerance has significantly improved. The patient had arrived at the right time which prevented any grave complication that might have arisen if any more time would have been lost with the patient progressively moving towards grave physical complications.
Heart Diseases and Women
Heart disease is the number one killer for both males and females in US today. Every 80 seconds a woman dies from heart disease and more than 3 quarters of these heart related deaths are preventable. While 80% of all females have atleast one risk factor for heart disease, most women do not consider heart disease to be their greatest health risk. 60% of Indian urban woman in the age group of 30-35 are at a risk of heart disease and most doctors observe that there is a 16-20% rise in Cardiovascular Disease (CVDs) among women in last 5 years. World Health Organization (WHO) targets to reduce premature death from CVD by 25% by 2025 in Southeast Asia region. While overall death rates from heart disease have declined over the last 20 years, death rates in women still outpace those in men. Earlier this year The American Heart Association (AHA) released a new scientific statement on Women and Heart Disease. AHA recognized that many times heart attacks in women have different causes and symptoms compared to those in men and women who develop heart attacks have higher complication and death rates during the first year after a cardiac event. February, this year was designated as “Go Red for Women” month. Its purpose was to raise awareness about heart disease in women and promote engagements in such a way that thousands of unnecessary and preventable cardiac deaths can be prevented. I think there is a similar need in India to start a campaign as most women generally think more about Breast Cancer and Cervical Cancer. However, more women die from heart disease than from Breast and Lung Cancer combined together. Breast cancer affects 1 in 8 women while heart disease affects 1 in 3 women.
What are the potential risk factors for women to develop heart disease?
- Since Diabetes has acquired epidemic proportions in Asian countries, women with Diabetes have more than three times the risk of developing heart disease. In my experience, premature Coronary Artery Disease is seen predominantly with Diabetic females
- Family history for premature coronary artery disease
- Obesity, especially abdominal
- Dyslipidemia (abnormal amount of lipids (e.g.,triglycerides, cholesterol and/or fat phospholipids) in the blood
One of the recently conducted surveys also showed that low levels of Estrogen due to changing lifestyle and other comorbid conditions is one of the major reasons for CAD in women. Talking of stress levels, there has been a significant change in the lifestyle of Indian women in the last couple of decades. While the Indian women are becoming equally participative at the work place, there is no major respite for them from the domestic duties. Add to this, the ever demanding children and limited family support on account of nuclear families, the level of stress in the female population is continuously increasing. Working women also have unhealthy food and do not get enough exercise, which also contributes significantly towards the rising incidence of heart disease in Indian women. Females with an Acute Coronary Syndrome are more likely to present with atypical symptoms. The classical chest pain could be replace by symptoms like profound fatigue, acute breathlessness, acute onset dyspepsia (indigestion), jaw or throat pain and severe upper back pain. Hence, many such females suffering from Acute Coronary Syndromes reach late to the hospital. It is also seen that lifesaving treatment like Primary Angioplasty are also offered to women less as compared to males, which is probably because they reach late, have smaller blood vessels and tend to have higher complication rates. It is also seen that women who survive a heart attack are less likely to be referred for cardiac rehabilitation.
What can every woman do to protect herself?
- Learn about the risk factors for heart disease and educate yourself, friends, family members and colleagues
- Learn about the symptoms of heart attack
- Your annual health check-up should also include cardiac evaluation besides gynecological and breast examination if you are above 30 years of age
- Seek emergency medical care when symptoms of heart attack as described above are seen in yourself or family members
- Remember that the first hour is the ‘Golden Hour’. Treatment given during this hour determines the short term and long term mortality
- Learn to de-stress yourself
- Have healthy food habits and say no to smoking. Advocate a smoke free environment at your workplace and home
Dr. Zakia Khan, Interventional Cardiologist, Fortis Kalyan