JIS News

Are you a female who smokes and has a waist measuring more than 35 inches, a non-active lifestyle, and suffers from a combination of life threatening conditions, including diabetes, high blood pressure and bad cholesterol?

It is highly likely that you are at risk of heart disease. In fact, smoking alone makes you twice more prone to diseases of the cardiovascular system than men.

According to the Heart Foundation of Jamaica, heart disease is the number one killer of women, and as the Foundation is currently observing Heart Month, it is seeking to make more women aware of their risk factors, and the different ways in which heart disease is manifested and treated in men and women.

Consultant Cardiologist at the Foundation, and at the University Hospital of the West Indies, Dr. Marilyn Lawrence-Wright, points out that diabetic women are 50 per cent more likely to have a heart attack than men who have diabetes.

Psychosocial factors are important as well. The Cardiologist refers to research carried out by the Canadian Institute for Health in 2008, which revealed that women who were depressed had an increased risk for developing heart disease, but that situation was not seen in the men in that population.

“Depression leads to inactivity and in some patients may increase the likelihood of smoking, and increases blood pressure,” she explains.

Heart attacks are caused by the interruption of blood supply to a part of the heart, causing cells to die. This is most commonly due to blockage of a coronary artery caused by an unstable collection of cholesterol, fatty acids, and white blood cells. If left untreated, this can cause damage or death of heart muscle tissue.

Narrowing of the small blood vessels that supply blood and oxygen to the heart is perceived as a man’s problem, but it is also an issue for women.

While women have an innate protection against heart attacks, this advantage no longer exists once the woman reaches menopause, Dr. Lawrence-Wright says. “Any protection that women would have from estrogen, that protection is going to be decreased or removed, once the patient reaches menopause,” she emphasises.

She also clarifies the misconception that, “if a heart attack doesn’t kill you, you will recover and be fine.”

“That is not true. Heart disease does kill more women than men each year. A woman is less likely than a man to survive her heart attack. If we look at the first six years after a recognized heart attack, 35 per cent of women, and 18 per cent of men will have a second one within that first six years. Heart disease does happen in women, and often it’s more lethal,” she states.

‘Classic’ Symptoms

A terrified man clutching at his chest and complaining of a squeezing pain, and who experiences pressure spreading to his shoulders, neck and arm, as well as shortness of breath, will almost instantly be recognized as being in the throes of a heart attack. These symptoms are known as ‘classic’ heart attack symptoms, but are generally more likely to be experienced by men than women.

A woman is more likely to complain about feelings of indigestion or gas-like pain, dizziness, nausea or vomiting, pain between the shoulders, or unexplained weakness or fatigue, Dr. Lawrence-Wright says.

While any of these symptoms can occur in a patient who is having a heart attack, clinical studies show that women are less likely to have the classic mid-chest pain that a man would.

The Cardiologist stresses that this is very important to know, because “one of the issues is that very often, cardiovascular disease in women is not recognized, because the symptoms are not so-called ‘classic’.”

Testing and Treating Heart Disease

Not only does heart disease tend to be more lethal in women, stress tests and angiograms are less sensitive or less accurate in women.

“So, a woman may either have a false positive or false negative test more easily than a man,” Dr. Lawrence-Wright says.

She notes that women are at a disadvantage with angiogram screening – which is considered the gold standard in screening for heart disease – because plaques in the arteries can be missed, as women tend to have discreet and fewer plaques, and tend to have more of a “discreet” picture when their angiograms are done.

An angiogram is an x-ray-based test that allows doctors to see the inside of blood vessels and organs of the body, particularly the arteries, veins, and the heart chambers.

Dr. Lawrence-Wright says that because women are less likely to receive blood thinners, they are at a higher risk of dying from a

The Cardiologist adds that because women have smaller coronary arteries, they are more likely to have coronary spasm, even if there is no build up of plaque.

It is also important to note that a woman’s fat tissues produce more inflammatory chemicals than a man’s, and this increased inflammation is believed to increase the risk of heart disease.

In terms of valve disease, she points out that the valves that help blood to flow in the right direction in women tend to be floppier, than in men, therefore causing a disorder called mitral valve prolapse to be more common in women.

Although an irregular heartbeat is more common in men, women tend to be more symptomatic, and heart rates tend to go higher.
Dr. Lawrence-Wright says recognition of these gender differences with heart disease, can improve how the disease is managed, and the outcomes, thus saving more lives.

Reducing Risk Factors

Persons can significantly reduce their risk of dying from coronary heart disease, by adopting a healthy lifestyle.

A low fat, low cholesterol diet, rich in fruit and vegetables is recommended, while avoiding concentrated sweets and processed foods, which can lead to obesity. Persons should also steer clear of excess alcohol.

Eating appropriate portion sizes is also important, even if one is following a proper diet, as excess, unused calories will cause weight gain.

Additionally, regular moderate to vigourous exercise is ideal, Dr. Lawrence- Wright points out, as this reduces the risk of heart attack, lowers blood pressure and improves overall well-being.

Reducing the risk of non-communicable diseases, such as diabetes and hypertension, which can compound the risk of heart disease, is a major thrust of the Ministry of Health.

The National Strategic Plan for the Prevention and Control of Non-communicable Diseases in Jamaica 2012 – 2017, which is in its draft stage, seeks to address risk factors for four main chronic conditions, including cancers, diabetes, cardiovascular disease and chronic respiratory disease.

A non-communicable disease is a medical condition, which is non-infectious and non-transmissible between persons. They are referred to as lifestyle diseases, because the majority of these conditions are preventable. The most common causes include tobacco use (smoking), alcohol abuse, poor diet (high consumption of sugar, salt, saturated fats, and trans fatty acids) and physical inactivity