Posted by: wockhardthospitals | August 12, 2009

Heart Disease In Women – A New Understanding

Women and Heart Disease – Be Proactive For Prevention

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Click image to know about services at wockhardt hospitals

Cardiovascular disease is the leading killer of women” says Dr. Zakia Khan, Consultant Cardiologist, Wockhardt Hospitals


Women’s increased risk for developing cardiovascular disease has become a hot topic in the field of cardiology across the world. The American Heart Association in order to spread the awareness of increasing risk of heart disease in women had also launched a campaign “Go Red For Women” a movement in February 2004. Since then, many American women have become more aware of the signs and symptoms of heart disease and how their symptoms differ from those of men. Similar awareness is also required on a priority basis in India as well as the incidence in India is also increasing sharply. Even more important than awareness, however, is that women be proactive and take steps to reduce their risk for heart disease, even before symptoms occur.



Although the lifetime risk of developing coronary heart disease is at least one in three for women, many Women are unaware that heart disease is one of the woman’s greatest threat to life. Cardiovascular disease is the leading killer of women. Heart disease is often considered primarily a “man’s disease” and is usually diagnosed later and treated less aggressively in women than in men. Though many similarities exist in CHD between the sexes, several important differences exist as well. Cardiovascular disease is a leading killer disease, affecting more patients than cervical cancer & breast cancer put together.


PRESENTATION AND SYMPTOMATOLOGY


Dr. Zakia Khan, Leading Consultant Cardiologist, Wockhardt Hospital said “Symptoms of heart disease have been found to differ in men and women. Men are more likely to have “typical” chest pain consisting of central chest location, aggravation by exertion, and relief by rest. Women, on the other hand, are more likely than men to report chest pain during rest, sleep, or periods of mental stress.”


INACCURACY OF NONINVASIVE TESTS


A critical first step toward improving heart disease outcomes in women is accurate diagnosis. The mainstay of early diagnosis is noninvasive testing: treadmill testing and exercise imaging studies has proven to be difficult in women. Studies have shown that the accuracy of noninvasive testing is lower for women than for men. Both specificity and sensitivity for detection of heart disease by treadmill testing have been found to be lower in women than in men. In the CASS study, for instance, the sensitivity of treadmill testing in women was 76%, and the specificity was 64%; in men, the sensitivity was 80%, and the specificity was 74%. Some of the causes for this lower sensitivity and specificity in women are greater incidence of false-positive during stress ECG in women. Combining imaging (eg, radio nuclide) with treadmill testing provides increased accuracy, however, poses unique problems in women. Breast tissue can cause artifacts and is even more problematic in obese patients.


DIFFERENTIAL IMPACT OF RISK FACTORS


Although women with Coronary Heart Disease (CHD) have risk factor profiles similar to those of men, the quantitative impact of a particular risk factor on overall CHD risks may differ between men and women.


Women who smoke risk having a heart attack 19 years earlier than non-smoking women. Smoking may increase a woman’s risk of heart disease more so than a man’s because it lowers levels of the female hormone estrogen. Women in high-powered jobs have an increased risk of heart disease compared with women who have little control over their work; the opposite is true for men. Unlike men with heart disease, some women – particularly younger women – who have a heart attack do not have high levels of fatty plaque clogging their arteries.


Dr. Zakia Khan further said “Women with diabetes are two to three times more likely to have heart attacks. High blood pressure is more common in women taking oral contraceptives, especially in obese women. Compared with men, 38% of women and 25% of men will die within one year of a first recognized heart attack. 35% of women and 18% of men heart attack survivors will have another heart attack within six years. 46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years.”


Women and men tend to have different average cholesterol levels at various times in their lives, primarily because of the effect of estrogen. Before puberty, there are no significant differences between the cholesterol levels of boys and girls. After puberty, when a woman’s ovaries begin producing estrogen, the level of HDL “good” cholesterol tends to rise while the level of LDL “bad” cholesterol tends to fall. This seems to have a cardio-protective effect, especially through a woman’s childbearing years. As menopause approaches, however, and estrogen levels begin to decline, the opposite effect takes place. HDL levels tend to drop, while LDL and triglyceride (another blood fat) levels rise. This rise in LDL cholesterol often takes place in conjunction with other changes that put a woman at risk, including increasing blood pressure, fat accumulation in the abdomen (a risk factor for heart disease) and weight gain. To combat this constellation of age-related risk factors, women are encouraged to maintain higher HDL cholesterol levels than men. Whereas men are advised to keep their HDL levels at or above 40 mg/dL, women are advised to keep their HDL level at a minimum of 50 mg/dL.


Hormone replacement therapy (HRT) involves the replacement of sex hormones, especially estrogen, that is lost during menopause. Until recently, it was believed that HRT may help reduce the risk of heart attack and stroke by replacing the estrogen lost to menopause. Today, neither estrogen/progestin therapy nor estrogen-only therapy are recommended for the prevention of heart disease. However, HRT may still be recommended on short-term basis to control a variety of menopausal and post-menopausal symptoms.


GENDER DISPARITIES


In the Framingham study, men were found to have about twice the total incidence of morbidity from heart disease, but this sex differential diminished significantly after approx­imately 45 years of age. In general, women lag behind men in first presentation of heart disease by about 10 years, but after menopause there is a rapid increase in heart disease rates such that rates in elderly men and women are similar. Another important finding from the Framingham study is that despite there being fewer cases of heart disease in women, the death rate for women exceeds that for men (32% vs 27%).Other studies have produced similar findings. For instance, in the GUSTO-I trial, women were found to have higher death rates after acute heat attacks at all ages, with the greatest differences being at the younger ages. Women are more likely to die in the hospital and in the 30 days following a heart attack than men. This is largely because women are older and sicker than men by the time they have a heart attack. In the long run (from 6 months to 10 years after a heart attack), men and women are just as likely to survive their heart attacks. Older women (over age 75) generally do better than men of the same age and are less likely than men to die after a heart attack. Heart attacks are less common in younger women (under age 50), but when they do occur, younger women are at a much higher risk of dying in the hospital than younger men. There is a greater incidence of heart attack without symptoms (silent heart attack)in women than in men. While heart attack is less common in women under 50 years of age, younger women with heart attacks fare worse than younger men.


Numerous studies have found that men are referred for noninvasive testing and invasive cardiac procedures such as coronary an­giography more frequently than are women. Women also appear to receive preventive services, such as cholesterol screening and risk factor modification, less often than do men. Understanding and correcting these gender disparities is essential for preventing heart disease in women.


Women are almost twice as likely as men to die after bypass surgery. Women are less likely than men to receive medications after a heart attack. More women than men die of heart disease each year, yet women receive only: 33% of angioplasties and bypass surgeries and 36% of open-heart surgeries.


One Interesting Case Study: Kavita Rane’s STORY (name changed)


As a school headmistress, I used to walk to school everyday about 2 kms until recently, I have started going by bus. I ate a healthy diet except for occasional snacks cooked in oil. I can never forget the day I first experienced breathing difficulty. That was the day I went to school in the afternoon as I had some work in the bank that morning. I returned back from school and at around 7.30 PM developed breathing difficulty. I was not feeling well and couldn’t lie down flat. That night I was often sitting up but managed to spend the night. Next day morning I consulted the nearest doctor. I had an ECG and told me it was abnormal and asked me to go to a higher centre. I got a shock and I never had any chest pain. What came to my mind was my mother who was a diabetic who had a heart attack at the age of 57 and died after a few months. I had also just completed 57 years and a diabetic for the last 4 years. I was in trouble and wasted no time in reaching the higher centre. The doctors there confirmed my worst fears. I was having a heart attack. I never thought I was at risk, except that my mother had a heart attack. My blood pressure was always normal. However, I’ve since learned that being postmenopausal diabetic women aged 57 would make me vulnerable to heart disease.


Looking back, I realize that there were some earlier signs. A few months before my heart attack, I had one or two episodes of shortness of breath with sweating whenever I had stress at work and had to walk briskly. I assumed this symptom was related to gastric problem.


As the headmistress of the school, I had lots of responsibilities with eight teachers working under me and we were building a new block in the school and imagine the stress I would have had walking pillar to post. I believe that this stress took a toll on my heart.


Gradually, I’ve returned to the active lifestyle that I love and I’m very optimistic about my future. It’s remarkable how far medicine has advanced—I had 2 drug-coated stents placed and I’m taking several medications. Even so, when it comes to understanding women and heart disease, there is so much more that needs to be accomplished. As a female heart attack survivor, I would love to live long and to serve and thrive to bring up children. Being in the school, I know how difficult it is in bringing up children.


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