February was Heart & Stroke Month and this year the focus was on women and heart disease. Did you know….
Women in Canada are unnecessarily suffering and dying from heart disease because of inequities and biases that have resulted in a system that is ill-equipped to diagnose, treat and support them. Heart & Stroke 2018 Report
So WHY is heart disease in women being overlooked?
First, most of our research related to heart disease has been done on men (2/3rd of it), and so assumptions have been made that men and women are physiologically similar, thus experience the same symptoms, and the same treatments work for both.
What we are realizing is that women and their hearts are different!
Research is slow and information dissemination is lacking. Our healthcare system needs to do more women-specific research and implement new evidence into practice.
Let’s get our GEEK on and first define heart disease.
To understand the disease, we must understand the function of a healthy heart.
Our heart is a muscle whose purpose is to pump oxygenated blood around the body. This process is incredibly intricate and complex – it’s amazing really!
Disease and illness are essentially anything that impedes the normal functioning of an organ or a system. So,
Heart Disease is any condition that affects the structure (vessels, heart structure, valves) and function (the pumping action of the muscle and electrical activity) of the heart.
Types of Heart Disease include:
Coronary artery and vascular disease are due to the hardening of the arteries (atherosclerosis).
Vascular diseases are problems in other blood vessels that reduce blood flow and affect the function of your heart.
Heart rhythm disorders (arrhythmias) cause the heart to beat too slowly, too quickly or in a disorganized fashion. Heart rhythm disorders disrupt blood flow.
Atrial Fibrillation (Afib) – this is when the heart doesn’t contract, it wiggles like jelly instead.
Atrial Flutter (Aflutter) – this is similar to Afib but is faster with a more disorganized beat.
Supraventricular Tachycardia – this is a rapid heartbeat caused by extra electrical activity in the heart muscle.
Bradycardia – this is a very slow heartbeat
Structural heart disease refers to abnormalities of the heart’s structure it includes valves, walls, muscles or blood vessels near the heart. It can be present at birth or acquired after birth through infection, wear and tear, or other factors.
Heart failure is a serious condition that develops after the heart becomes damaged or weakened. The two most common causes of heart failure are:
High blood pressure
Unfortunately, there is no cure, but early diagnosis, lifestyle changes, and medication can help people lead an active life, stay out of the hospital and live longer.
For more information regarding “How a Healthy Heart Works” or “Types of Heart Disease” check out:
While men and women’s hearts look the same, there are important differences and we are still trying to fully understand the scope of it through on-going research.
The important differences can be classified as being one of the following categories which will be further explored.
Anatomy and physiology
Signs and Symptoms
Anatomy and Physiology
Women’s hearts are physiologically different from men’s:
Smaller hearts and coronary arteries
Lower blood pressure and faster resting heart rate than men of similar age
Differences in the way atherosclerotic plaque builds up in the blood vessels causing coronary heart disease
Differences in the heart’s electrical patterns
What are the causes of heart disease? What are the risk factors that affect women in particular? Women do have UNIQUE risk factors that contribute to overall heart health. In addition to the following general risk factors for heart disease:
A woman’s risk of heart disease and stroke changes over her lifetime
Family history of heart disease (genetics)
Race (African, Asian, Indigenous)
Personal circumstances/environmental factors (food security, access to clean water, access to healthcare and social services).
Conditions that contribute risk:
High blood pressure
Stress (we significantly underestimate the amount of stress women experience because they cope so well)
Excessive alcohol or drug use
Women are UNNECESSARILY dying because of HEART DISEASE because they are unaware of their risk or the threat of heart disease in women!
Women Specific Risk factors:
Estrogen can be cardioprotective and changes depending on a variety of factors and conditions.
For example post-menopausal women who have established atherosclerotic disease, estrogen increases the risk of myocardial disease through the effects on plaque stability and clot formation (The ESHRE Capri Workshop Group, 2006).
In women under < 35 y/o who don't smoke, contraceptive use does not increase the risk of stroke.
In a small proportion of women, oral contraceptives increase the risk of high blood pressure and blood clots. The risk is greater if you:
Have high blood pressure
Blood clotting disorder
Migraine headaches with aura
> 40 y/o
Have other risk factors
Being pregnant doesn’t increase your risk but developing the following conditions during pregnancy can increase your risk:
Pre-eclampsia is related to increased blood pressure and protein in your urine.
Gestational Diabetes occurs when there is an overproduction of insulin and an inability for the body to effectively use it.
The lack of estrogen due to menopause increases your risk of heart disease in ALL women. Lack of estrogen causes:
An increase in “bad” cholesterol
A decrease in ‘good’ cholesterol
An increase in blood pressure
An increase in central body fat (which leads to an increase in blood clots and blood sugar problems.)
Symptoms such as severe sweating or sleep disturbances
Studies show that even though 9/10 women have at least ONE of the risk factors, most women underestimate their risk. Among women at the highest risk, more than half downplay their risk as low or moderate. These women-specific risk factors are new to me and awareness of this has now changed my clinical practice significantly!
Knowledge is POWER, do YOU know your RISK?
Knowing your risk is essential for prevention.
Signs, Symptoms, and Screening
While the primary symptom of a heart attack is chest pain which both men and women experience. The type of pain and the way women describe it are different. Even the symptoms of heart attacks in men and women are different. Women also experience more subtle symptoms such as fatigue and dizziness and these in combination with the description of their pain impact how they are diagnosed and treated.
While most healthcare providers recognize these differences, women aren’t aware. Often young women attribute their symptoms to anxiety or indigestion rather than seeking the medical attention that they may require.
Women need to know that they can have a heart attack yet continue to walk, talk, work. - Carolyn Thomas, heart attack survivor
Due to symptoms being less dramatic the research shows that women are receiving less care or are being dismissed. Screening tests to rule out cardiac causes are automatic in men presenting with any type of chest pain, while women are often not offered these same tests.
While access to screening tests are one barrier to care, the other is that our current screening to detect cardiac disease and angiogram is inaccurate in women. Women generally experience small vessel disease and an angiogram will only assess large vessels. Also, stress testing to test cardiac function is less accurate in women. Having these tests done can provide a false sense of reassurance.
At this time new cardiac screening tests to detect small vessel diseases are being researched.
So Now What?
What’s the solution, how can we change the outcome? Decrease the number of women dying unnecessarily.
First, prevention is key!!
Second, knowledge is power! Be well informed.
Third, know your risk factors!
Fourth, get a check-up at least every 3 years.
Fifth, know your numbers (blood pressure, cholesterol, c-reactive protein and blood sugar values).
Last, know your family history.
Manage your modifiable risk factors.
We underestimate the importance of our diet, stress management, sleep, hydration, exercise on our overall health and wellbeing.
You can significantly improve your health by making a 1% improvement in your lifestyle weekly, over the course of weeks to months that’s huge. That’s obtainable and sustainable. Thinking you must make drastic changes like going vegan when you hate vegetables, dropping 80 lbs, and running 5 days a week when you can’t walk down the block is overwhelming and unachievable for most.
What can you do to improve your health by 1% this week?
Maybe it’s putting down the pop or going for a 10-minute walk once or twice a week. Small increments of change over time lead to BIG results. Losing 5-10 % of your body weight has huge overall health benefits. Having support from family, friends, and professionals like dietitians and trainers increase our success. We don’t have to do this alone and in silence.
Next, work with your Primary Care Provider to screen for chronic illnesses like hypertension, high cholesterol, and diabetes and manage them if diagnosed. Listen to your intuition, when asked most women felt their symptoms were more than the diagnosed anxiety or indigestion. Advocate for your care!
Share this information with every person you meet!
Check out the associated podcast for the audio experience, or watch my video!
Thanks for reading, stay healthy until next time.