Don't skip a beat: Understanding heart health in women

Cardiovascular disease or heart disease is the top reason women die worldwide. Heart disease is responsible for 35% (so 1 in 3) of deaths in women each year - more than all cancers combined, according to the World Heart Federation. The Federation also shares that 13 times more women die of heart disease than of breast cancer.

So, what is heart disease?

Cardiac electrophysiologist, Dr Kaveshree Govender explains: "Heart disease is a broad term for conditions that affect the heart and blood vessels."

Types of heart disease include:

• Coronary artery disease (blockages in the heart's blood vessels which can cause heart attacks)
• Arrhythmia (irregular heartbeats)
• Strokes (when blood vessels in the brain block or burst)
• Congenital heart disease (heart conditions that a person is born with)
• Heart failure (a broad term used for poor heart function from multiple causes including from chemotherapy medicine often used to treat breast cancer)

Why do women have poorer outcomes than men when it comes to heart disease?

A study in the International Journal of Environmental Research and Public Health says that heart disease in women is often overlooked and that women are less likely than men to receive the treatment they need.

Dr Govender explains why this is the case: "Women often have symptoms that aren't necessarily typical of heart disease. While men might have chest pain - which is an obvious symptom of a heart attack, women might feel tired, nauseous, have trouble sleeping, feel weak, or dizzy. These symptoms don't always make doctors think of heart problems right away, so women's symptoms often aren't checked as thoroughly as men's."

"Also, most research and clinical trials into heart health have been done on men. Men usually have bigger hearts than women, so the parameters we use to identify heart diseases in women may not give us the information we need, as the parameter refer mainly to male heart health. The same is true when it comes to medicines to treat heart disease. Most tests for these medicines are done on men, but some medicines work differently in women than in men."

"If doctors don't investigate and diagnose women properly, it goes without saying that they won't get the right treatment, which leads to poorer outcomes."

What are the risk factors for heart disease in women?

The World Heart Federation also shares that high blood pressure is the number one risk factor for heart disease in women.

"Only 48% of women with high blood pressure have it under control," says Dr Govender. "One reason is that women often prioritise caring for others over themselves, which can delay their being screened for high blood pressure or from seeking care or sticking to their treatment.

Also, doctors don't treat high blood pressure in women as aggressively as they do in men. It's critical to keep in mind that high blood pressure is called a silent killer as it's a condition that can be present without a person feeling any symptoms at all until something serious happens."

• Read more about high blood pressure and how a simple blood pressure test could save your life.

"Then, some risk factors for heart disease are the same for both men and women, but their level of risk might differ."

For example:

• A woman who smokes has a 25% higher chance of getting heart disease than a man who smokes, according to a study published in the Journal of Thoracic Disease.
• A woman with diabetes has a 44% higher chance of heart diseases than a man with diabetes, according to the American Heart Association.
• Obesity raises the risk of heart disease by 64% in women compared to 46% in men, according to a study published in the International Journal of Obesity.

Other general risk factors for heart disease for both women and men are:

• Genetics/family history of heart disease
• Hypertension (chronic high blood pressure, as mentioned above)
• Autoimmune conditions

There are also risk factors for developing heart disease that are specific to women. These are:

• Pre-eclampsia (hypertension that happens in pregnancy)
• Gestational diabetes (high blood sugar or diabetes diagnosed for the first time during pregnancy)
• Preterm birth
• Polycystic ovarian syndrome

"Early menopause (before the age of 44), can increase the risk of heart disease because oestrogen, a hormone that protects the heart, decreases as women get closer to menopause. This drop in oestrogen raises the chance of developing heart disease."

How can women reduce their cardiovascular risk factors?

"Some risk factors for heart disease can be reduced by making healthier lifestyle choices. This includes controlling your blood pressure, cholesterol and blood sugar, staying at a healthy weight, quitting smoking, and drinking less alcohol. Regular health checks can help you know your health status and catch the onset of risk factors as early as possible. Stress can also lead to heart disease, so it's important to manage your stress."

"If heart disease runs in your family, ask your doctor about additional screenings, like an ECG, and check on how often you should get them."

"If you had gestational diabetes or pre-eclampsia during pregnancy, keep monitoring your blood sugar and blood pressure even after your baby is born. Visit your doctor regularly if your levels continue to remain high and be sure to take any prescribed medicine."

Be empowered to take charge of your heart health

"Heart disease treatment is the same for both women and men," says Dr Govender. "This includes medicines to lower cholesterol or control blood pressure. What is important is for doctors to focus on better identifying heart disease in women and to treat it just as aggressively as they do in men."

• The Cardio Care Programme provides Discovery Health Medical Scheme members with cover for top quality care. Your Premier Plus GP can diagnose and start treatment while managing your risk factors with the support of a skilled healthcare team. To join the Cardio Care Programme, you need to see a Premier Plus GP and be registered for one of these conditions under the Chronic Illness Benefit: Hypertension (high blood pressure), ischaemic heart disease, or hyperlipidaemia (high cholesterol).

"I want to encourage women to take charge of their health. Get regular check ups for your overall health and heart health, and treat your preventive checks for heart health as important as regular checks for breast or cervical cancer."

• Read more about screening tests every woman needs.

"If you have any symptoms that worry you, don't ignore them. See your doctor and make sure you're clear on the feedback you get. Women know their bodies well, so trust your instincts. Be persistent in finding answers, even if this means changing doctors when you feel your needs are not being met, or getting a second opinion. Do your own research and don't hesitate to ask your healthcare provider questions. You have the right to be actively involved in your health and to understand your health status, any treatment plan given to you or anything else that is important in keeping healthy."