The way to a woman's heart



Every year September 29 is observed as "World Heart Day" to "encourage everyone throughout the world to take action and protect himself from the very real threat of cardiovascular disease, and to call on governments to support population-wide programmes to increase physical activity".

It so happens that while it comes to heart disease, the focus is often on men. But the truth is women are as susceptible to the disease as men. Not just women, these days children's heart ailments are on focus too.  Perhaps quite aptly the 2013 World Heart Day will "highlight a life-course approach to the prevention and control of cardiovascular diseases (CVD) with a focus on women and children and show what actions can be taken through a person's life to reduce their risk of cardiovascular disease".

According to World Health Organisation(WHO), CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. What is alarming is according to WHO over 80% of CVD deaths occur almost equally in men and women.

According to the World Health Federation, heart disease is the number one killer of women, causing one in three deaths. Putting it in perspective, speaking to Thursday magazine, Dr Devi Prasad Shetty, India's prominent cardiothoracic surgeon and chairman, Narayana Health says, "Women till the age of 45 are generally protected by the hormones.  

"However, after the age of 45 they are as vulnerable as men in developing heart disease.  However, women who are diabetic and women who smoke are at much higher risk. 

Women generally have narrow coronary artery which can result in poor outcome following cardiac intervention.  Women in India are more vulnerable for valvular heart disease and one out of 140 children born anywhere in the world has a heart disease."

Advising women to be alert, he says, "Women generally tend to ignore their symptoms because of their major commitment to the family especially in Indian context.  So, their disease gets priority after taking care of the need of the breadwinner and the children.  In the process, women present to the heart hospital at an advanced stage."

Talking about children Dr Shetty says, "In India 28 billion children are born every year and we produce at least 600-800 children a day with heart disease.  If children are given healthy food, their chances of developing heart disease gets significantly less when they grow up to be adults."

Dr Shetty, who heads Narayana Health in Bangalore a 3,000 bed Health City with major interest in heart, cancer, bone marrow transplant, renal, neuro says, "Children should avoid junk food, eat healthy vegetarian diet with fish and chicken however, avoid red meat.  Fatty food, fried food should be avoided and children should exercise.  Coronary artery disease starts at a very young age especially during childhood."

Women must remember that CVD is not just a male disease. It is time that they start perceiving CVD as among the greatest threat to their health.

Women and heart disease and stroke   
Worldwide, cardiovascular disease is mainly seen as a male problem, whereas breast cancer is considered to be the most important chronic disease in women. However, cardiovascular disease (CVD) is the largest single cause of death also in women, accounting for approximately one-third of the deaths, while breast cancer is responsible for less than 5%. CVD causes 8.5 million deaths among women annually.

It's the largest single cause of mortality among women, accounting for one-third of all deaths in women worldwide. In developing countries, half of all deaths of women over 50 are due to heart disease and stroke.

Projections for coronary heart disease (CHD) death rate in developing countries suggest that it will increase by 120% for women and 137% for men during the next two decades. The Middle East is expected to be among the regions that will experience a tripling of CHD and stroke deaths.

Heart disease and stroke occur more commonly in those individuals who have certain risk factors; these include those with a family history of premature heart disease, advancing age, those after menopause, those with high blood pressure, diabetes, high cholesterol, those who smoke and lack in physical exercise.

In fact, many women have at least one risk factor for cardiovascular disease (heart disease and stroke). Women who have diabetes or are menopausal are at the highest risk.  It is important for every woman to know about their risk factors and recognise the warning signs for heart disease and stroke so that they can prevent and manage them.

Women and heart attack
Are the warning signs of heart attack the same for women? In the past, it was believed that women and men had different warning signs of heart attack. This may not be the case. Both women and men may experience typical or non-typical symptoms such as nausea, sweating, pain in the arm, throat, jaw or pain that is unusual. However, women may describe their pain differently than men. Nevertheless, the most common symptom in women and men is still chest pain.

Women tend to be safeguarded from heart disease prior to menopause because of the protective effect of oestrogen.  However, this is not always the case. For example, pre-menopausal women with diabetes have similar risk to men of the same age because diabetes cancels out the protective effect of oestrogen.

The role of oestrogen
During a woman's reproductive life cycle, from about age 12 to 50, the naturally occurring hormone, oestrogen, provides a protective effect on women's cardiovascular health. However, oestrogen's protective effect can change depending on a variety of factors and conditions.   

Pills
Pills' used by women are much safer than the forms used decades ago. In women under the age of 35 who don't smoke, the use of Pills does not increase the risk of stroke. However, in a small proportion of women, Pills  do increase the risk of high blood pressure and blood clots. The risk is greater if the person is a smoker, already have high blood pressure and especially if over the age of 35 years, have other risk factors for heart disease or stroke, or already have a blood clotting problem.

Pregnancy
Over the nine months of gestation, women may develop certain conditions that put them at higher risk of heart disease.

•Pre-eclampsia is a condition that typically starts after the 20th week of pregnancy. It is related to increased blood pressure and protein in the mother's urine (the protein indicates that there is a problem with the kidneys). The risk factors for developing eclampsia include being younger than 20 or older than 40, are pregnant with more than one baby, or have diabetes, kidney disease, rheumatoid arthritis, lupus or scleroderma. All women should be monitored by their healthcare provider throughout their pregnancy and have their blood pressure checked often. Pre-eclampsia is treatable under the supervision of a doctor.

Gestational diabetes: While pregnant, a woman's body must produce extra insulin because increasing levels of pregnancy hormones interfere with the body's ability to use insulin efficiently. If the woman's body can't produce the additional insulin sufficiently, her blood sugar levels may rise, causing gestational diabetes.

There are no warning signs so it is important that women get tested for diabetes as part of their prenatal care and continue to be monitored throughout their pregnancy. Although gestational diabetes usually disappears after the baby is delivered, it can increase the risk of the mother and baby developing diabetes later in life.  Diabetes is a major risk factor for heart disease and stroke in women.

Menopause

Menopause is a time when a woman stops having menstrual cycles. Once reached menopause, the overall risk of heart disease may increase due to the reduction in the hormones oestrogen and progesterone produced by the body. After menopause, there is more chances for the following:

• An increase in total blood cholesterol, low density lipoprotein cholesterol (LDL or 'bad' cholesterol) and triglyceride levels

• A decrease in high density lipoprotein cholesterol (HDL or 'good' cholesterol)

• A tendency toward higher blood pressure

• An increase in central body fat, which can be harmful to your body because you may be more prone to blood clots and blood sugar problems. Symptoms such as severe sweating or sleep disturbance.

• Hormone Therapy (HT) refers to different types of oestrogen and progestin that a woman may take to ease some of the symptoms related to menopause.

 Randomised controlled trials have shown that HT does not reduce the risk of heart disease or stroke, or prevent future heart disease or stroke. It is not recommended to begin or continue to use HT, either oestrogen alone or combined oestrogen-progestin, for the sole purpose of preventing heart disease and stroke. Discuss all health risks and benefits of HT with your healthcare provider.

• After menopause, as natural oestrogen levels drop, more and more women tend to develop high cholesterol.

Triglycerides
Triglycerides are the most common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and an increased risk of diabetes. Research suggests that having high triglycerides may increase the risk of heart disease and stroke for women.

Making heart-healthy changes in life
A woman's overall risk of heart disease or stroke is determined by all of her risk factors. One can control some of these risk factors, but not all of them.

The modifiable risk factors include smoking, high blood pressure, high blood cholesterol, diabetes, physical inactivity and obesity.

Risk factors one cannot control (non modifiable risk factors) include age, gender, family history.

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