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Women and Heart Disease

January 28, 2015

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Consultant Cardiologist at The Physicians’ Clinic Dr Amanda Varnava discusses why heart disease in women is under recognised and how you can do your best to prevent heart disease.

Heart disease is the commonest cause of death in both men and women. In fact ten times as many women die of heart disease than of breast cancer. Despite these facts, for many people heart disease is seen as more of an issue for men. Women who do have heart disease are often under-investigated and thus under-treated.

This fact partly relates to the fact that for many women a heart attack does not always present with the classic symptoms of a vice-like tightening across the chest. In fact, up to 43% women have no chest pain during their heart attack, but instead have sudden onset of marked fatigue, breathlessness or back pain.

An increased awareness of these less typical warning symptoms, particularly in women at increased risk of heart disease (such as those with high blood pressure; diabetes; a strong family history of heart disease and smoking) may allow earlier identification of women having a heart attack.

A new research paper (http://www.bmj.com/content/350/bmj.g7873) has found another way in which we can increase the appropriate identification of women having heart attacks. A blood test (high sensitivity troponin I assay) has been available for some time. This test measures the level of heart muscle protein released into the blood during a heart attack. Until this research, the cut off levels for an abnormal test (suggesting a heart attack) were the same for both men and women. This study showed that if different cut off levels were used (16 for women and 34 for men) then the number of women identified as having a heart attack, and thus appropriately treated, was doubled. This study therefore offers the opportunity of correctly treating more women with heart attacks, thus saving lives.

Beyond this study however, it is important to realise that although many women are spared heart disease until the menopause, after that their risks significantly increase. It is therefore important that everyone takes care of their heart health and the earlier this starts the better. Being aware of your family history is important. If there is a family history of heart disease at young age or of a close family member dying suddenly and unexpectedly before 60 years then it might be appropriate to get a heart check. Discuss this with your GP.

Of course we all know the importance of not smoking. Lastly a check of your cholesterol and blood sugar to rule out diabetes would be sensible, particularly form 40 years onwards. For women, even high blood pressure confined to pregnancy may be an issue for heart disease in the future and regular checks of blood pressure and cholesterol are important.

Lastly, but perhaps most importantly, keeping physically active is extremely beneficial. This should take the form of at least moderately vigorous exercise for a minimum of 30 minutes 3 times a week. This could be jogging, swimming, cycling or sports such as tennis. Undertaking this level of exercise on a regular basis not only protects individuals form heart disease, but from many types of cancer too.

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