Heart disease in Women Cardiovascular disease is the leading cause of death in women, regardless of age or ethnicity and causing the death of one in three women. About half of these deaths (1 in 6) result from Coronary Heart Disease (CHD) commonly referred to as Angina/ Heart Attack. Although overall deaths from heart diseases (both in men & women) has decreased, mortality among young women (between 35- 44 yrs of age) increased by 1.3% per year between 1997 to 2002. Regarding CHD, there are significant differences in the occurrence, presentation & Course of the disease and in some cases, in treatment and response to therapy. Risk Factors for Coronary Heart Disease in women • Age: Symptoms of Angina/Heart attack occurs approx 10 years after those in men. However risk of death from heart attack is two times higher in young middle aged women than men. • Family history: Heart attack/Angina occurring prematurely in female relatives (Esp. before 65
years of age) is a more potent risk factor than premature CHD in male relatives. • Hypertension (High Blood Pressure): High blood pressure is more prevalent in women than men. Unfortunately, in our country women are less likely to receive treatment than men. • Diabetes: Women With diabetes are 3-7 times more likely to have CHD. • Lipid (cholesterol) : Abnormalities are common in women especially after 45 yrs of age. • Smoking : Prevalence of smoking especially in young females is increasing. Smoking is more detrimental in women than men. • Physical inactivity/Lack of exercise : sedentary life style is more common in female than males. It promotes obesity which increases the risk of dying from CHD. Differences in Clinical Presentation: Classical symptoms of heart attack includes chest pain/ chest pressure localized to the centre of the chest & occasionally radiating to the neck, jaw, shoulder, arm or back. It is usually associated with breathlessness, swelling, vomiting, heartburn, nausea & palpitations. Women are less likely to experience these classical symptoms. In them pain may be present only in the arms, jaw, back, shoulder or upper tummy. Commonly they may experience only indigestion, faintness, generalized weakness or sweating- so called ‘Atypical’ symptoms. Women are also likely to have more risk factors than men. They are also at a higher risk of dying suddenly from a heart attack than men. Therefore early recognition of so called Atypical/Non specific symptoms of CHD are of great importance if proper treatment strategies are to be implemented that will reduce the number of women dying of CHD. Diagnosis: Commonly used modalities to diagnose CHD like the ECG, Treadmill Test (Stress Test) and stress thallium scan are also less accurate in women than men. Management of CHD in Women: Women with CHD in our country, even today are undertreated. Amongst the drugs used even aspirin & cholesterol lowering drugs are less often prescribed to women than men. Women with heart attacks are less likely to be subjected to Angioplasty (ballooning)/Stenting and Bypass Surgery, though both procedures are proven more beneficial in them than men. Finally, early recognition of symptoms of CHD in females is important-needing heightened public/physician awareness of the atypical features so, that timely & appropriate treatment can be instituted at the earliest saving precious lives.
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