Cardiovascular disease has long been considered a men’s health issue – but more women are dying from it.
I began to get a headache like I had never had before,” says 37-year-old Priscilla Chandro. “It was intense, but I didn’t know what caused it. I went to the kitchen to get paracetamol, but on the way I felt so hot I had to lie on the sofa. Once the wave of heat had passed, I got up again. But then I passed out and woke up staring at the kitchen ceiling.”
The symptoms of heart attacks in women are often much subtler and very different from those in men.
What Chandro was suffering from was in fact a massive heart attack. She did not believe it had happened to her. But neither did the paramedics who had rushed to her home, who said she had flu. Nor did a GP who initially examined her. It wasn’t just that Chandro, a working mother of a four-year-old daughter, from Ottershaw, Surrey, had a normally healthy lifestyle and no family history of cardiovascular disease. The symptoms of heart attacks in women are often much subtler and very different from those in men. And we still somehow don’t believe that women get heart disease, even though it kills three times more women than breast cancer does.
Finally scientists and doctors are accepting that women’s coronary problems are physically different from the male model upon which medical therapies are traditionally based. This opens a path to new treatments and preventive tactics. And not before time. For although coronary heart disease is considered a problem for overweight middle-aged businessmen, it is in fact the most common cause of death for British women.
Emotional stress may play a role in some forms of women’s heart disease. Last week it was reported that research by the University of Arkansas showed that shock or emotional trauma can damage the heart. It also stated that women are seven and a half times more likely to suffer “broken-heart syndrome”, or stress cardiomyopathy, a condition where intense emotional or physical stress can cause rapid and severe heart-muscle weakness, than men.
Vera Regitz-Zagrosek, director of the institute of gender in Berlin, says that high psychological stress plays the key role in 90 per cent of cases of a particular form of heart failure in women. “We are only just becoming aware of how much women are in danger from this syndrome,” she says.
Chandro says: “A heart attack was the last thing I could ever have imagined. It seemed like a cruel joke; not something that happened to women, especially young ones. I felt extremely frightened. People just don’t believe that it could have happened to me.”
But it frequently does, according to Jane Flint, a consultant cardiologist who chairs the British Cardiovascular Society’s joint working group for women’s heart health. “In 2010, 77,000 men died from cardiovascular disease. The same year, 80,000 women died from it,” she says. “A third of deaths in men are from this, and a third of deaths in women are, too.”
One reason for the female death rate is that women tend to wait longer than men before calling 999 after first experiencing heart attack symptoms. Experts speculate that this might be because women are reluctant to cause a fuss, or they don’t want to be embarrassed if it turns out that their situation isn’t serious.
The difference in symptoms also plays a role. Many men’s heart attacks fit with the picture of chest pain that spreads to the shoulder, arms, back, teeth or jaw, along with shortness of breath. Women’s signs can be much more vague and insidious.
A study of 500 female cardiac patients by the National Institute of Nursing Research reports that the most common symptoms that women experienced in the month before a heart attack are unusual fatigue, sleep disturbance, indigestion and anxiety. Forty per cent had no chest pain, even during an attack. Other research says that women are more likely to experience achiness or tightness across the chest during a heart attack, along with symptoms such as pain in the jaw, nausea, sweatiness, breathlessness and feeling light-headed.
But it is not only the symptoms that are different. The physical causes of women’s heart attacks can differ considerably too, and therefore require different treatment. Last week, leading cardiologists gathered at the University of Mississippi to explore these disparities at an international conference. High on the agenda was research suggesting that while men commonly suffer blockages, specifically in the arteries supplying blood to the heart, women’s heart disease is often spread more widely in their bodies. Dangerous fatty clots accumulate more evenly inside women’s major arteries and in smaller blood vessels.
Because women’s arteries are generally smaller than men’s they are more easily blocked. And the widespread nature of potential blockages makes it harder to diagnose the disease in a woman, and makes it more deadly if she has a heart attack, the conference was told by C. Noel Bairey Merz, the director of the Women’s Heart Center in Los Angeles. His figures show that more than a third of women will die within a year of their first heart attack, compared with a quarter of men. Women are twice as likely as men to have a second heart attack within six years of their first, he adds, and women are twice as likely as men to die after bypass surgery.
In addition, medical research often fails to differentiate between men and women in tests of drug therapies. Dr Flint says: “We know that heart drugs can have different effects according to your gender. But only half of the drug trials conducted into heart drugs since 2006 showed results by gender. And of the people tested, two thirds were men.”
Dr Flint says that statin drugs offer a clear example of the importance of gender-specific research. “Until recently, it was thought that women did not benefit from taking statins the way that men do. Thankfully, research shows otherwise now, though that is little comfort to women who have missed out. And even now, only about a third as many women are given statins as men. The message has not yet fully got out.”
Other drugs can have totally different effects on the sexes. Only in 2009 was it discovered that a daily aspirin regimen for men helps to protect against heart attacks, but offers no protection for women. (On the other hand, that same aspirin will protect women against strokes but has no such power for men).
Lifestyle plays a part too. The British Heart Foundation reports that about a third of women in England and Scotland have high blood pressure. More than half of all women in the UK are overweight or obese and less than a third in the UK do enough exercise to protect their hearts. It is recommended that these women begin to take regular readings with a blood pressure monitor to see if it is getting to high
For Priscilla Chandro, the idea of emotional stress playing a part in her heart attack feels particularly true. “I am convinced that my heart attack was brought on by all the intense emotional stress I had put myself under. After it happened, I decided to deal with all the sadness and anger that I had always carried around with me, to change my attitude and beliefs.”
Chandro was extremely lucky to have survived her massive coronary, given the late diagnosis. If more of us learn to watch for the subtler signs of a female heart attack, many more women may get that second chance of life, too.
The symptoms for women
The most common symptoms that women experience in the month before a heart attack are, say researchers:
Unusual fatigue, which was noted in 70 per cent of the women monitored
Sleep disturbance, which affected nearly half of them
Shortness of breath
Indigestion
A heightened sense of anxiety
During a heart attack, further research shows that women may feel:
Tightness across the chest (although 40 per cent of women don’t feel any chest pain)
Pain in the jaw
Nausea
Sweatiness
Breathlessness
Light-headedness
Source – The Times
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