Cardiovascular disease in women: How to stay heart healthy
Learn more about cardiovascular disease and how to stay heart healthy. Presented by Thomson Cardiology Centre, Thomson Medical Centre.
Heart disease, combined with stroke, is the leading cause of death In Asia. It accounts for 25-30% of all death in Asia. It is also a leading cause of premature deaths in adults at 20-25%. Premature mortality is defined as death at an age that is below the standard life expectancy age of that community. In Singapore, it accounted for 29.6% of all deaths in 2015.
Even then, many are still unaware of the dangers posed by this “mass killer,” thus allowing it to slip in unawares.
Heart health is an important part of your overall well-being—arm yourself with information about the causes and risk factors of heart disease so you can stay heart healthy, and be aware of warning signs.
What are the causes of heart disease and stroke?
Heart disease risks can be reduced, and heart diseases can be managed. The common causes of heart disease are coronary artery disease (CAD), hypertension and atrial fibrillation (abnormal heart rhythm). These conditions, if undiagnosed or poorly controlled, can lead to heart attacks, heart or kidney failure, stroke, dementia, and sudden cardiac death.
The most common cause of CAD and heart attacks is atherosclerosis. It is the “typical” or “classical” form of CAD— you are probably already aware of this kind of heart disease—with “classical” symptoms of chest angina (pain or discomfort) on exertion, or if more severe, even at rest. It is more common in men, post-menopausal women and diabetics of either gender.
“Typical” CAD is a disease in which plaque builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich blood to the heart muscle. Plaque is made up of cholesterol, calcium, and other inflammatory substances found in the blood.
Over time, plaque can harden or rupture. Hardened plaque narrows the coronary arteries and reduce the flow of oxygen-rich blood to the heart. This can cause chest pain, tightness or discomfort called “angina.”
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.
When this process occurs in the brain, a stroke happens.
What are the more common female heart conditions?
#1 Late onset of atherosclerotic or “typical” CAD
Most women with CAD have a "typical" form of this disease. However, women tend to have this condition about 10 years later than men.
This is likely due to the cardio-protective effect of oestrogen. When their CAD is diagnosed and treated in a timely fashion, these "older" women have similar outcomes as men of the same age.
#2 Atypical forms of CAD
In the last 30 years, there has been great progress in typical CAD therapy. As a result, death rates from heart disease have dropped. However, they haven't dropped as much in women as in men.
This may be the result of atypical forms of CAD, which are seen more often in pre-menopausal women, than in men.
In contrast to discrete distinct plaques in larger coronary arteries in typical CAD, there are several forms of atypical CAD. These include coronary artery spasms (Prinzmetal's Angina), coronary artery small-vessel blockages (Cardiac Syndrome X), diffuse coronary artery stenosis (Female-Pattern CAD) and Coronary artery erosions.
The symptoms of these atypical forms of CAD are also different to those of “typical” angina and are outlined below.
Standard tests for CAD are designed more to detect the typical forms of CAD. Thus, these tests may not detect atypical CAD. That’s why it is crucial that women be more aware of the symptoms of atypical CAD.
While research is still ongoing to learn more about these atypical types of CAD, their causes and specific therapies, at present, they are managed with medications, lifestyle modifications and risk factor management.
#3 Atypical presentations of coronary artery disease and heart attacks
Instead of typical angina chest pains, women are more likely to experience atypical symptoms. These include a hot or burning sensation, or even tenderness to touch, located in the back, shoulders, arms or jaw. Women may also experience nausea, vomiting, indigestion, shortness of breath, or unusual, extreme fatigue—nothing that may be construed as “chest pain.”
At times, women, especially those with diabetes mellitus, may have no noticeable symptoms at all. This makes heart attack in women a “silent” killer.
#4 “Broken heart” syndrome
“Broken heart” syndrome is a well-recognised cause of acute heart failure, and it could lead to lethal heart rhythm and heart rupture. It is more commonly seen in postmenopausal women. Often there is a history of a recent severe (usually negative, sometimes happy) emotional or physical stress, such as the death of a loved one, or sudden relationship issues.
This condition is also called stress-induced or Takotsubo cardiomyopathy (weakening of the heart muscle). Treatment lies with addressing the stress trigger, and medications to counter the stress effects on the heart, and avert potential complications.
What are other health issues associated with heart disease?
The risk factors for heart disease are common in our community. They include diabetes, high cholesterol, high uric acid (which can lead to gout) and obesity. These conditions are usually due to physical inactivity, poor food choices, smoking, excessive stress, and inadequate hours of good quality sleep.
How can you prevent heart disease?
Most risk factors for female heart conditions are preventable. The key to this is adopting a heart-healthy lifestyle. Here are our top tips:
- Adopt healthy lifestyle habits. Reduce your stress levels. Practice “mindful eating” with a deliberate, balanced diet—more fruits, vegetables and whole grains. Make it a point to consume less salt, simple sugars, fat and oils. Cook your food in a healthy way, with more steaming and less deep frying. You should drink six to eight glasses of fluid daily—choose water over sugary drinks, and drink coffee or tea without sugar. Avoid smoking.
- Get active. Start by standing and walking more, and gradually progress to a healthy exercise regime. See your family doctor for a health check if you are starting an exercise programme, especially if you experience shortness of breath on exertion or have any existing medical conditions.
- Go for regular health reviews or check-ups. Every individual or family should have a family doctor for regular health care. Visit your family doctor regularly for reviews, and take your medications as prescribed if you already have heart disease or a health issue. Manage it by changing your lifestyle. Work with your healthcare professionals, who are your partners in your journey to good health!
Even if you have no symptoms, you should still for your regular health checks. This is especially important if you smoke or have a family history of heart disease or its risk factors, e.g. diabetes.
Dr. LEONG KUI TOH GERARD
Thomson Cardiology Centre
Thomson Medical Centre
339 Thomson Road, #05-05
T: 6717 0008