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Women and heart disease: Q&A

Dr Angie Brown

Medical Director of the Irish Heart Foundation

Medical Director of the Irish Heart Foundation, Dr Angie Brown, answers five questions and dispells some myths on women’s risk of heart-associated illnesses.

“About one third of all women in Ireland will die of cardiovascular disease. Yet, many women still view a heart attack as mainly being a man’s problem rather than being an issue for them too.”

1. How does women’s heart health/physiology differ from men’s?

“In many cases, women are even more vulnerable to risk factors for heart disease and stroke than men. Factors such as smoking, being overweight or obese, having high blood pressure, high cholesterol, being inactive or having diabetes and a family history of cardiac problems all differ in women and men.”

Women are 6x more likely to die of cardiovascular disease than breast cancer.

“For example, women metabolise nicotine a lot faster than men, so a cigarette will increase a woman’s risk of heart attack a lot more than it will in a man. Women who smoke are also twice as likely to have a heart attack than women who have never smoked. A large percentage of heart attacks in women under the age of 50 is due to smoking.”

2. What are the different symptoms that women experience?

“In women, the symptoms of a heart attack can sometimes be quite vague. A woman may have nausea, tiredness, shortness of breath, back pain or tightness in the jaw rather than the more familiar scenario of a crushing pain in the chest that shoots down the arm. It can be very hard to diagnose and that’s why heart disease and heart attack is often missed in women.

“One of our most important messages is to advise women who are experiencing these symptoms not to delay. Call 999 for an ambulance and get to A&E. Irish research shows that one of the reasons many women die from heart attack is that they delay in getting to A&E.”

3. Does this get worse with age?

“A woman’s risk of suffering from a heart attack does increase with age. Up until the menopause, women are protected by their hormones. After the menopause, however, the reduction in oestrogen levels leads to increases in LDL (the bad cholesterol) and a decrease in the good cholesterol. Blood pressure tends to rise also.

“The menopause compounds many traditional cardiovascular risk factors, including changes in body fat distribution to increase the risk of central obesity, reduced glucose tolerance (thus increasing the risk of diabetes), increased blood pressure, increased sympathetic tone, endothelial dysfunction (increases arterial stiffness) and vascular inflammation. In postmenopausal women, treatment of arterial hypertension and glucose intolerance should be priorities.”

4. How does heart disease compare with other illnesses like breast cancer? 

“Most women think they are going to die of breast cancer, when in fact they are six times more likely to die of cardiovascular disease. One reason for this is that women are protected by their hormones and present with heart problems a few years later than men, but after the menopause, a woman’s risk of heart disease catches up with that of a man’s.”

5. Are Irish women more/less at risk than women internationally?

“Overall, our death rates from heart attack and stroke have decreased in Ireland over the last 20 years; we are no longer classified as a high-risk country in Europe. However, the concern is that with rising levels of obesity, hypertension and diabetes, this downward trend will be reversed and not only will levels rise but, potentially, they could start affecting younger people.”

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