Why are women more prone to heart disease? Aparna Karthikeyan talks to medical experts, who lay emphasis on how proper diet and adequate physical activity can play a preventive role

Here’s a quick question — who, do you think, is more prone to heart problems? The usual answer is men. “But the right answer is actually women,” says Dr. Sivakadaksham, Consultant Cardiologist. “Women live longer, so at any given point of time, more women suffer from heart disease. The only difference is, heart problems occur 8 to 10 years later in women than they do in men.” Cardiovascular disease, he says, is a leading cause of death among women, and this is regardless of race or ethnicity.

Women receive protection from the hormone oestrogen as long as they menstruate, which is why a post-menopausal woman, who complains of chest pain needs to be thoroughly investigated. Except, now, the scenario is changing, says Dr. K. Jayanthi, Senior Interventional Cardiologist, SRM Institute for Medical Sciences. “Because of increasing stress levels, lack of exercise and changing diets, even when a woman who is in her 4th or 5th decade comes with non-specific uneasiness, we need to look at her risk background and check her for heart disease,” she says. And this is true, even if the woman is thin, is below age 50, and does not smoke or drink, says Dr. Sivakadaksham. “If there’s a strong family history, where a first-degree relative has suffered heart problems around the age of 50, we need to take care,” he says.

Risk factors

Risk factors are broadly divided into non-modifiable and modifiable ones. Non-modifiable causes include those that cannot be altered, such as age and a genetic predisposition to heart problems. Modifiable causes include tobacco, hypertension, diabetes, obesity, cholesterol and stress, all of which can be controlled either with lifestyle changes or medication. “Some older women say they don’t smoke, but they consume a paste of betel nut and tobacco. In the younger generation, cigarette smoking is quite prevalent,” says Dr. Sivakadaksham. Diabetes, he says, increases the risk of cardiac problems two-fold, and the attacks are more serious when they occur; and obesity, on the other hand, leads to metabolic syndrome, which in turn makes the person resistant to insulin. “Insulin resistance itself leads to heart diseases, as the cardio vascular system gets affected,” he says. “Diabetes also nullifies the hormonal protection offered by oestrogen,” says Dr. Jayanthi, adding that it is no longer possible to rule out heart problems in women merely taking into account their age. “Their risk background needs to be carefully evaluated,” she says.

The symptoms of heart disease are the same, be it men or women; but, the way the two sexes react, to the typically crushing chest pain, or the more atypical general unease, or prickling sensation (that feels like gas) is quite different. “Women tend to underplay their symptoms,” says Dr. Jayanthi. “They ignore the indications of heart disease, and the problem is compounded by a lack of awareness.” “Women tend to get alarmed and bring their husband or sons at the first sign of a problem, but they disregard their own symptoms,” adds Dr. Sivakadaksham.

Once heart disease sets in, the treatment options are the same for either sex. But the prognosis for women over age 65 with diabetes is slightly poorer compared to men, says Dr. Jayanthi. “The 1st 30 day mortality is also slightly higher in women than in men; and this is the case across the world. The 1 year mortality, however, is similar for both men and women,” says Dr. Sivakadaksham.

Does HRT help?

Earlier, hormone replacement therapy (HRT), after menopause, was viewed as a preventive measure. “But HRT does not bring down the incidence of heart disease; on the contrary, it increases the risk of stroke and pulmonary complications,” says Dr. Sivakadaksham. “Aspirin, however, can be administered to a woman, who is diabetic, over the age of 50, with 1 or more risk factors,” he says.

“Lifestyle changes must start in school,” says Dr. Jayanthi. Children must be taught to keep healthy, maintain a good level of exercise, and learn how to tackle stress. “Stress is everywhere, and from childhood, we need to counsel people to handle stress, so that it does not lead to depression, which, in turn, can precipitate heart problems.”

Dr. Sivakadaksham advises his patients to spend quality time to look after their health. “But with more women working, when I say walk for 45 minutes, they usually ask me, ‘where is the time?’ So I tell them not to take the elevator; carry files themselves; and try to walk back home, at least part of the way, so as to incorporate the daily walk into their routine.” Many women, he says, have gone on to follow this, and found it extremely useful. And given that the scales are tipped a little unfairly against women, prevention might just be as important as the cure.