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Heart Disease in Women

Heart Smart Talk

February 5th 2016

Heart Disease in Women

Each year in the United Stats and other countries, the month of February is observed as Heart Month. In Jamaica we observe heart month with several activities over the course of the month led by the Heart Foundation of Jamaica, the Cardiology Unit at the University Hospital of the West Indies and other cardiologists and heart centres promoting awareness of heart disease prevention and early detection and treatment. This year, the theme for heart month is Sudden Cardiac Arrest.

The first Friday of February is also typically observed as Go Red for Women day, raising awareness for heart disease in women in particular. This is because heart disease is typically believed to be a disease predominantly affecting men, but women are equally affected by heart disease and the symptoms tend to be less dramatic and typical and as a result are often ascribed to other diseases. This is of course close to my heart, as a woman and as a cardiologist taking care of women with heart disease.

My personal story is that I have been diagnosed with high cholesterol and have a strong family history of Hypertension. Though high cholesterol is not in itself heart disease and the link between some types of high cholesterol and blocked arteries is controversial at best, there is a lot of science supporting the role of high cholesterol in the development of atherosclerosis ( blocked arteries). Coupled with Hypertension and poor diet, a sedentary lifestyle and other risk factors such as diabetes and cigarette smoking, women can develop atherosclerosis at a young age. When I share my story with patients, they always say, “but doc, you are not fat”. That is the thing about heart disease in women, though obesity is a cardiac disease risk factor, many women who are of ideal weight are not the healthiest – hence the need for early screening for heart disease and heart disease risk factors in ALL women. In my particular case all the women in my family have high cholesterol and it seems we have familial high cholesterol – which is a genetic defect, affecting how the liver handles cholesterol. Learning about this has encouraged me to be more attentive to my diet and physical activity levels.

In the United States, 1 in 4 women dies from heart disease. The most common cause of heart disease in both men and women narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and it happens slowly over time. It’s the major reason people have heart attacks.

Heart diseases that affect women more than men include
• Coronary microvascular disease (MVD) – a problem that affects the heart’s tiny arteries
• Broken heart syndrome – extreme emotional stress leading to severe but often short-term heart muscle failure
The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women can take steps to prevent it by practicing healthy lifestyle habits.

Not all heart disease is preventable, there is some heart disease that women are born with – called congenital heart disease such as mitral valve prolapse, and “hole in the heart” conditions such as Atrial Septal Defects and Ventricular septal defects and more complex congenital heart disease. These congenital heart diseases though account for the minority of cases of heart disease, usually less than 5%. So acquired heart disease linked to unhealthy lifestyle choices and other risk factors account for the majority, which means you can do something to lower your risk of developing heart disease, or get tested early and regularly.

So what can you do?
• Know your numbers – get screened for heart disease by age 20 years old. This can be done with your family doctor, sit with your doctor and have them go through your history in detail and examine you thoroughly, adding some blood work – Blood glucose, cholesterol CRP(Marker of inflammation) to your evaluation. Additional testing such as ECG would be at the discretion of your doctor. If your initial screen is good, then your doctor would recommend follow-up every 5 years. At age 40, schedule at least an annual review.
• Keep moving! Plan to have do at least 150 minutes of moderate physical activity per week
• Eat well – eat a diet rich in fruits, vegetables, whole grain and low in processed foods and simple carbs
• Self-care – a buzz phrase for the last few years, but such an important aspect of life, particularly as a woman. We often put the interest of others – ahead of ours, and neglect self care. Take care of your emotional needs, have positive self-talk, rest well and check in with yourself often. Emotional stress is one of the leading causes of presentation to the cardiologist with symptoms of anxiety and depression.

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