What Every Women Needs to Know About Heart Disease

Posted by Dr Chan Wan Xian

  1. Heart disease has been the leading cause of death in Singaporean women the past decade

Heart diseases have been the leading of cause of death among women in Singapore and world-wide. One in three women die of heart diseases every year. Yet, only 9% of women in Singapore were aware that heart diseases are common in Singaporean women, according to a heart health survey conducted by the Singapore Heart Foundation in 2020. Also, few women discuss with their doctors about their heart health when they go for health screening. Definitely, more can be done to increase the awareness of heart diseases in women and the importance of regular health screening for heart diseases and related medical conditions such as hypertension, diabetes, lipid abnormalities, adiposity-based chronic disease among women in Singapore.

  1. Women have unique risk factors associated with heart disease

Diabetes, hypertension, lipid abnormalities, adiposity-based chronic disease, smoking and physical inactivity are established risk factors of heart disease. Gender differences exist for risk associations of these risk factors with heart disease. Studies have shown that diabetes and smoking confer a higher risk for heart disease and stroke in women when compared to men.

There are emerging, nontraditional risk factors of heart disease which are more common in women. Autoimmune diseases (ie. systemic lupus erythematosus, rheumatoid arthritis, psoriasis etc.) cause inflammation response in the body which can damage the linings of blood vessels resulting in atherosclerosis (buildup of cholesterol plaques) and increase the risk of heart disease. Treatments used in breast cancer including chemotherapy medications and radiation therapy also increase the risk of heart failure and heart rhythm disorders.

On top of these, women have female-specific risk factors occurring during pregnancy such as hypertension disorders during pregnancy, gestational diabetes, peripartum heart failure, preterm delivery. There conditions increase the risk of heart disease and complications subsequently throughout the women’s lives.

Menopause is a natural aging process when female hormones decline and menstrual cycles cease. It is associated with significant metabolic changes in the body and increases the risk of impaired glucose tolerance, diabetes, lipids abnormalities, hypertension and blood vessels endothelium dysfunction. This contributes to the increased risk of coronary heart disease in women with increasing age.

  1. There are heart conditions more common or occur only in women

Just like in men, coronary artery heart disease due to atherosclerosis is the most common cause of heart attack in women. However, women also have higher risk of being diagnosed with other less common coronary artery diseases such as spontaneous coronary artery dissection and non-obstructive coronary artery disease which are other causes of heart attack.

Spontaneous coronary artery dissection (SCAD) is an emergency condition when a tear occurs on the interior lining of the coronary artery causing blockage or slowing of blood flow to the heart, resulting in a heart attack. SCAD most commonly occur between 40-50 years of age, with women comprising of up to 90% of cases. The most common cause of pregnancy associated heart attack is SCAD.

Non-obstructive coronary artery disease occurs when the coronary arteries inappropriately constrict or when the interior lining of the coronary arteries or their tiny branches malfunction. This could limit blood flow to the heart muscles and can cause heart attack to happen. Women presenting with heart attack are twice as likely as men to have heart attack due non- obstructive coronary artery disease.

The Broken Heart Syndrome or stress cardiomyopathy (also known as Takotsubo cardiomyopathy) is a condition when there is transient enlargement of the heart and weakening of the heart muscles resulting in inability of the heart to pump normally. This is usually caused by intense emotional (ie. bereavement, grief, fierce argument or intense fear) or physical stress (ie. severe illness, medical procedure or surgery) although the cause is not fully understood. Symptoms and presentation are similar to heart attack. The heart function typically recovers after treatment and medical support. Broken Heart Syndrome is more common in women.  Women older than 55 years have ten times the risk compared to men of similar age group.

A woman’s heart undergoes significant physiological changes during pregnancy to meet the increased metabolic demands of mother and fetus. Heart and blood vessels disease is now the leading cause of death in women during pregnancy and after delivery, and accounts for over 30% of pregnancy-related maternal deaths. This is a fact that women need to be informed so precautions can be taken by going for screening prior to conception and preventive measures if there were pre-existing at risk medical conditions.

Peripartum cardiomyopathy is a form of heart failure when the heart enlarges and the heart muscles weaken, occurring towards the end of pregnancy or in the early months following delivery. The underlying causes are unclear and likely involve virus exposure, nutritional deficiency, hemodynamic stress during pregnancy or abnormal immune response. Typical symptoms include feeling breathless with difficulty lying flat and significant swelling of the legs. Treatment approach is targeted at supporting and improving heart function with medications and intensive support which may involve mechanical heart pumps. The heart function improves or recovers in most cases within 3 to 6 months, however, there are cases when heart failure progresses requiring permanent mechanical heart pumps or heart transplantation.

  1. Women tend to have atypical symptoms when presenting with heart disease

Women have similar symptoms and clinical signs as men when they present with heart attacks. However, atypical and non-classic symptoms such as shortness of breath, light-headedness, cold sweats, fatigue, feeling of nauseous occur more commonly in women when they present with heart attack. This, together with the observation that women tend to delay seeking medical evaluation when they are symptomatic, may explain why the diagnosis of heart attack is often delayed in women. Delayed diagnosis commonly results in more complications and worse outcomes in women presenting with heart attack.

  1. Simple Heart healthy lifestyle habits can prevent heart disease

A heart healthy lifestyle goes a long way in preventing heart disease. Heart healthy lifestyle habits include:

  1. Eat a heart healthy diet (increase plant-based food, replace saturated with unsaturated fats in diet, reduce salt intake, restrict free sugar consumption, restrict alcohol consumption)
  2. Exercise regularly (more than 150 minute of moderate intensity aerobic exercises per week, add moderate- to high-intensity muscle-strengthening activity, such as resistance or weights, on at least 2 days per week)
  3. Stop smoking
  4. Maintain a healthy weight (body mass index between 18.5-25)
  5. Rest well and reduce stress

Regular health screening is important to identify medical conditions (such as diabetes, high blood pressure, high cholesterols) which increase the risk of developing heart disease. Prompt and early treatment of these medical conditions decreases the chance of getting heart and blood vessel diseases.

Start the new year on the right note. Begin with a heart healthy lifestyle by ndrdrstarting heart healthy habits together with your family and friends. Arrange for regular heart health screening. Take action  promptly and start treatment early should any medical condition arise.