Heart diseases in women different from men

Heart diseases are the leading cause of death in women. Previously, it was believed that heart disease is more of a man’s problem than women,  but now it is seen that women are equally affected by it. 

Risk is under appreciated: a survey done by American Heart Association showed that women on day to day basis still worry more about getting a breast cancer rather than considering heart disease a greater personal health risk.

Also, heart diseases are usually seen at older ages, so it does not seem that of a real risk as compared to other health problems to younger women.

Heart diseases different in men and women: Research shows that men and women can experience different diseases and can suffer from different types of heart diseases. 

Bairey Mers, the director of Women’s Heart Center at Cedars-Sinai Heart Institute,  stated that women’s heart diseases should be referred as ischemic heart disease.  

Heart diseases in men usually develop due to the blockage in coronary arteries and this condition is known as Obstructive Coronary Artery Disease (CAD).  Whereas in women this disease develops within small arteries that branch out from the coronary arteries. This is referred to as Microvascular disease (MVD). It has also been seen that upto 50% of women with anginal symptoms who undergo cardiac catheterization, don’t have obstructive CAD.

Sex difference in coronary risk factors: differences in risk factors are; 

a. Blood lipids: before menopause, a woman’s own estrogen helps in protecting her from heart disease by increasing the levels of HDL (good cholesterol) and decreasing the levels of LDL (bad cholesterol). After menopause, women have higher risk of heart disease because of higher concentrations of total cholesterol than men.

b. Metabolic syndrome: Harvard Medical school research suggests that for women,  metabolic syndrome is the most important risk factor for developing heart diseases at unusual early age.

c. Diabetes: increases the risk of heart disease in women more than in men. Perhaps, because women with diabetes more often have added risk factors like obesity, hypertension, increased cholesterol. If a woman was to develop a heart disease 10 years later than man, diabetes eradicates this advantage. 

d. Smoking: women who smoke are twice as likely to have a heart attack as male smokers. Moreover, women find nicotine replacement therapy not very effective and their menstrual cycle affects tobacco withdrawal symptoms and this may result in getting inconsistent outcomes or results with anti smoking medications.

e. Oral contraceptives: birth control pills are believed to increase cardiovascular risk factors in women, especially when other factors (like smoking) coexist. These pills tend to increase the blood pressure and blood sugar levels in some women and tend to increase risks of blood clots in others, eventually leading to higher risk of heart problems.

f. Depression: according to American Heart Association, depression screening should now be a part of overall evaluation of woman for cardiovascular risk.

g. Risk factors specific to women: high testosterone levels prior to menopause, increased blood pressure during menopause, autoimmune diseases like rheumatoid arthritis, low risk factor awareness. 

Effects of stress different in men and women with heart diseases: (Monday October 13, 2014 Health day news) stress triggers different physical and mental reactions in men and women with heart diseases. A study was done which involved 254 men and 56 women with stable heart disease and they performed 3 mentally stressful tasks; a math test,  an anger recall test and a mirror tracing test. Results showed that in men, stress had a greater impact on blood pressure and heart rate. While in women decreased blood flow to heart and increased clumping of blood cells associated with blood clots was noted.

Top heart attack symptoms in women: symptoms a month before heart attack… unusual fatigue, sleep disturbances, shortness of breath, indigestion, anxiety.

Symptoms during a heart attack… shortness of breath, weakness, unusual fatigue, cold sweat, dizziness, nausea, arms weakness and heaviness. 

Many times these symptoms in women are misdiagnosed for signs of stress, panic attacks, and even hypochondria.

Men usually experiences crushing type pain in chest that radiates down the left arm, whereas women may complain of pressurized pain or pain in neck,  jaw, abdomen, lower chest that may spread to shoulder or arm.

Diagnosis and treatment: women possess smaller and lighter coronary arteries as compared to men, hence making angiography, coronary bypass, angioplasty more difficult in them. Women responds to standard exercise stress tests differently,  making it difficult to interpret results. But these problems are diminishing with time due to advances and increased research,  making it better to understand the heart diseases in women. 

Role of Pharmacist:  pharmacists are the most accessible,  knowledgeable and trusted health care professionals who play a key role in helping those with heart disease by actively interacting with male and female clients. Pharmacists can also participate in community health information fairs and seminars focusing on different heart disease related issues and treatment in men and women. Pharmacist is in the best position to provide guidance on 

a. weight gain and loss to patients who have heart disease and are obese.

b. dietary management. 

c. cardiovascular medication use and compliance and adherence to the treatment regime.

d. patients with heart diseases and trying to become pregnant or start birth control pills. 

e. menopause and CV diseases and guidance  topically applied or vaginally inserted estrogen products.

f. and on thousands of other related patient concerns and problems.

Heart disease may start in childhood,  develop silently overtime and arrive without a warning, so we should not wait for symptoms to appear before taking proven steps to reduce our risks and should try to adopt a healthy lifestyle which would help in reducing the cardiovascular risks.

Reference: 

1. American Heart Association

2. Circulation vol. 108

3. John’s Hopking Women’s cardiovascular health center.

4. Harvard Medical school research.

5. CDC Facts and tools every women can use.

 

 

 

 

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