How is Heart Disease in Women Different?

By Dr. Zakia Khan, Senior Consultant, Interventional Cardiology, Fortis Hospital, Kalyan

Heart disease is referred to various types of heart conditions that also include Coronary Artery Disease, heart defects, congenital heart defects, Heart Attack, etc. It is a common notion that heart disease is a man’s disease; however, there is a high prevalence of diseases of the heart in women too! Despite various awareness attempts and increasing conversations over the past few years, only about half (46%) of women recognize and acknowledge the threat of heart disease as the number 1 killer. This WORLD HEART DAY, let us understand how Heart Disease is different in women, and why it is of utmost importance to pay heed to.

Heart disease symptoms in women are often different from men; the seriousness of the issue lies in the fact that women are more likely to succumb within a year from having a heart attack than men! It is also noted that women do not seem to have the same results like men do when it comes to Anticoagulants (blood clot medication) or even after undergoing certain cardiac medical procedures. It is commonly understood that Estrogen protects women from Heart Disease, but that’s not the case anymore.

Differentiating heart disease in women from men will help tune out symptoms and lead to early diagnosis and prevention, here are a few differentiators:

ESTROGEN: Increase in HDL (good) cholesterol and decreasing LDL (bad) cholesterol due to Estrogen present before menopause, helps protect women from Heart Disease. Post menopause, cholesterol concentrations is higher in women than in men. Elevated triglycerides also contribute to the risk of Cardiovascular Diseases (CVD) in women. The risk of death due to Heart Disease is seen in women above 65yrs due to Low HDL and high triglyceride levels as contributing factors.

DIABETES: Women with Diabetes are often faced with further risk factors such as Obesity, high cholesterol and Hypertension, hence greater the risk of Heart Disease. Women who have experienced a heart attack, if diagnosed with Diabetes as well, their risks of a second heart attack increases twofold, also increasing the threat of heart failure.

DIFFERENCE IN SYMPTOMS: Amongst women faced with heart disease, the disease appears in smaller blood vessels of the heart also known as micro vascular disease – that needs to be identified and treated promptly. The symptoms are not typically the classic crushing chest pain like in men. Women are more likely to experience:

• Chest discomfort
• Shortness of breath
• Fatigue
• Indigestion or nausea
• Back, shoulder or neck pain

Tests: Angiograms are less effective in diagnosing Micro vascular Disease. False positive Stress Test is more common in females. Women are also more prone to Stress Cardiomyopathy, and tend to have smaller Coronaries & Radial Arteries. Women are more prone to Radial Artery Spasms following Transradial Interventions. Heart failure with preserved Left Ventricular Ejection Fraction is also more common amongst females.

While stated above, women in the age group of 40-50yrs are at a higher risk of Heart Diseases due to many reasons. However, statistics indicate that about 10%-15% female patients with Heart Attack today are in the age group of 25 to 35yrs! Some of the causes include:

• Adoption of sedentary lifestyle
• Family history of cardiac diseases continue to be the #1 culprit
• Stress
• Smoking
• Air pollution, both indoor and outdoor is also a major contributing factor

Women can decrease the risk of Heart Disease by implementing the following tips:

• Be more active: Get about at least 30mins of daily moderate-intensity exercise

• Follow a healthy diet: A heart-healthy diet includes a variety of fruits and vegetables, whole grains, and nuts. It is also important to reduced Sodium intake and limitthe intake of Trans Fats

• Quit smoking: The chances of a woman having a heart attack doubles due to smoking, so kick the butt!

• Decrease stress: Chronic stress as well as Depression could increase the risk of heart disease. Seek professional help; speak to a Mental Health expert. Follow stress reducing techniques such as meditation and yoga, get adequate sleep and speak to your loved ones

Heart Diseases in women are not detected early, primarily because they put the family’s needs before themselves. Remember, lifetime risk of a woman dying from heart disease is eight times greater than that of Breast Cancer! So look after your overall health, begin early check-ups, and schedule annual checks as prescribed by your doctor.

The Risk of Heart Disease from Oral Contraceptive Pills

 By Dr Brajesh Kumar Kunwar, Senior Interventional Cardiologist & Dr Manjiri Mehta, Senior Consultant Gynaecologist and Obstetrician, Hiranandani Hospital, Vashi-A Fortis Associate

The burden of cardiac conditions is on an increase; with widespread fear about COVID19, heart health is not being paid attention to. When it comes to diseases of the heart, both men and women are at the receiving end. Women are susceptible to a number of health issues. And in India each year, more women are dying of heart disease as compared to men-which is often overlooked! This World Heart Day 2020, observed on the 29th of September, let’s look at a woman’s reproductive well-being; and the close association between the use of oral contraception and its impact on heart health.

 It is a well-known fact that birth control is not widely discussed, leading to lack of awareness, which in return impact a woman’s health. Using Oral Contraceptive Pill (OCP) or different other birth control measures which contain hormones is the preferred and safe method in preventing pregnancy. However, some women may be at a higher risk of heart related diseases, Heart Attacks or Strokes as well as blood clots. It is imperative to be prescribed birth control measures by your physician only, avoiding self- prescription is imperative. This will enable women to discuss the pros and cons with their physician, and effectively manage their health.

 How can oral contraceptive pills raise heart risk?

Known as the ‘hormonal birth control measure’ by doctors; hormones Estrogen and Progestin are essential components of a pill. Other forms of pregnancy control which include injections, patches, Intrauterine Devices (IUDs), Vaginal Rings and Nexplanon-which is a device implanted under the skin, all contain the two hormones.

 As per studies, the Heart may be affected in various ways due to the hormones found in these forms of pregnancy control measures. For instance, your blood pressure could increase; so it is important to get your blood pressure checked every six months if you take these pills in order for the blood pressure to stay in a healthy range. You may also consult your doctor about other safer ways to control your blood pressure and prevent pregnancy, both options that would suit you better. Taking certain birth control pills may cause a change in some of your blood fats that contribute to Heart Disease. An example as such is the levels of HDL (or good cholesterol could) decrease and at the same time Triglycerides/ LDL (or bad cholesterol) may increase. This could lead to a build-up of Plaque (fatty substance) inside your Arteries and over a course of time, reduce or block blood flow to your Heart, causing a Heart Attack or Angina (form of chest pain). The formation of blood clots could be a potential risk due to the Estrogen in birth control pills.

Risk of heart disease and other complications is higher when on OCP, if you:

·        Are over 35yrs of age

·        Have existing conditions of High Blood Pressure or High Cholesterol, Diabetes

·        Are a smoker

·        Have a history of Stroke, Heart Attack, or Blood Clots

·        Experience Migraines with aura                               

Lowering risk of heart disease when on OCP:

You may still be able to use birth control if you are at a risk of Heart Disease even if you fall under the categories listed above. What is imperative is that you must discuss all your concerns with your doctor.  They will assist in weighing the pros and cons, against each birth control option, offered to you. 

For example, those women with existing medical conditions such as high Blood Pressure and Diabetes may be able to safely take birth control pills if the said conditions are kept under control. You may continue using hormonal birth control if you are over 35yrs and healthy and a non-smoker. However, if you have ever experienced Blood Clots, Stroke, or Heart Disease, do not use birth control with Estrogen. As an alternative, consult your doctor about pregnancy control methods that only contain Progestin. These include shots, a type of birth control pill called the mini pill or POP, Nexplanon, and Intrauterine Devices (IUDs). For women with congenital heart disease, using most forms of birth control is permissible. As per research, Progestin-only options as well as IUDs is the safest option. 

Your doctor will be the best confidant for you to make the best choice!