Have a heart - it's Women's Heart Month

March is National Women’s Heart Month in the Philippines. This aims to increase awareness among Filipino women on the importance of a healthy lifestyle to prevent heart disease. After all, heart disease is the leading cause of death among Filipino women — and it is one of the most preventable. Almost four out of 10 deaths among Filipinas are due to diseases of the heart and the cardiovascular system. Yet, in a 2009 survey by the Philippine Heart Association, most Filipinos thought that the leading cause of death in Filipino women is cancer

In a similar survey by the American Heart Association, about half of the women interviewed knew that heart disease is the leading cause of death in women, yet only 13 percent said that it was their greatest personal health risk. Other survey data suggested that on a day-to-day basis, women still worry more about getting breast cancer — even though heart disease kills six times as many women every year. Why the disconnect?

Breast cancer affects body image, sexuality, and self-esteem in ways that a diagnosis of heart disease does not. Also, heart disease tends to show up at an older age (on average, a woman’s first heart attack occurs at age 70), so the threat may not seem all that real to younger women. Most 50-year-old women knew women their age who’ve had breast cancer but none who’ve had heart disease.

In addition, many women say their physicians never talked to them about coronary risk and sometimes don’t even recognize the symptoms, mistaking them instead for signs of panic disorder, stress, and even hypochondria.

Sex Differences Evident

Until recently, most of our ideas about heart disease in women came from studying it in men. But there are many reasons to think that it’s different in women. A woman’s symptoms are often different from a man’s, and she’s much more likely than a man to die within a year of having a heart attack. Women also don’t seem to fare as well as men do after taking clot-busting drugs or undergoing certain heart-related medical procedures.

Research is only now beginning to uncover the biological, medical, and social bases of these and other differences. The hope is that new knowledge will lead to advances in tailoring prevention and treatment to women.

Differences In Coronary Risk And Treatment

New research, in fact, has started to identify gender differences in heart disease that may help fine-tune prevention, diagnosis, and treatment in women. Here are some examples:

• Blood lipids. Before menopause, a woman’s own estrogen helps protect her from heart disease by increasing HDL (good) cholesterol and decreasing LDL (bad) cholesterol. After menopause, women have higher concentrations of total cholesterol than men do. But this alone doesn’t explain the sudden rise in heart disease risk after menopause. Elevated triglycerides are a especially powerful contributor to cardiovascular risk in women. Low HDL and high triglycerides appear to be the only factors that increase the risk of death from disease in women over the age 65.

• Diabetes. Diabetes increases the risk of heart disease in women more than it does in men, perhaps because women with diabetes more often have added risk factors, such as obesity, hypertension, and high cholesterol. Although women usually develop heart disease about 10 years later than men, diabetes erases that advantage. In women, who’ve already had a heart attack, diabetes doubles the risk for a second heart attack and increases the risk for heart failure.

• Metabolic syndrome. This is a group of heart risks — large waist size, elevated blood pressure, glucose intolerance, low HDL cholesterol, and high triglycerides — that increases your chance of developing heart disease, stroke, and diabetes. Research suggests that for women, metabolic syndrome is the most important risk factor for having heart attacks at an unusually early age. In a study of patients undergoing bypass surgery, metabolic syndrome produced a greater risk for women than it did for men of dying within eight years.

• Smoking. Women who smoke are twice as likely to have a heart attack as male smokers. Women are also less likely to succeed in quitting, and women who quit are also more likely to start again. Moreover, women may not find nicotine replacement as effective, and — because the menstrual cycle affects tobacco withdrawal symptoms — they may get inconsistent results with antismoking medications.

• Symptoms. Many women don’t experience the crushing chest pain that is a classic symptom of a heart attack in men. Some feel extremely tired or short of breath. Other atypical symptoms include nausea and abdominal, neck, and shoulder pain. In one study, women reported deep fatigue and disturbed sleep as much as a month or two before a heart attack. During a heart attack, only one in eight women reported chest pain; even then, they described it as pressure, aching, or tightness rather than pain.

• Diagnosis and treatment. Women have smaller and lighter coronary arteries than men do. This makes angiography, angioplasty, and coronary bypass surgery more difficult to do, thereby reducing a woman’s chance of receiving a proper diagnosis and having a good outcome. Women tend to have more complications following surgery. And they’re twice as likely to continue having symptoms several years after coronary angioplasty. (They’re usually older than men and have more chronic conditions at the time of their first coronary event.) Women’s responses to standard exercise stress tests are also different from men’s, so it’s difficult to interpret the results. Fortunately, these problems are diminishing, thanks to advances in technology and better understanding of heart disease in women.

What You Should Do

Several things under your control can help reduce your risk for heart disease.

• Don’t smoke, actively or passively. Your chance of having a heart attack doubles if you smoke as few as one to four cigarettes per day. Even if you don’t smoke, regular exposure to someone else’s smoke can increase your risk.

• Be more active. Get at least 30 minutes per day of moderate-intensity exercise, such as brisk walking, most days of the week. Fit even more activity into your life: Take the stairs rather than the elevator, do gardening, park farther from your destination and walk.

• Eat healthfully. Studies have identified several crucial ingredients of a heart-healthy diet — whole grains, a variety of fruits and vegetables, nuts (about five ounces per week), poly- and monounsaturated fats, fatty fish, and limited intake of trans fats.

• Reduce stress and treat depression. Your risk for heart disease increases if you’re depressed or feel chronically stressed. Stress-reducing strategies include exercise, adequate sleep, relaxation techniques, and meditation. Psychotherapy can be especially helpful with depression and anxiety.

• Reach for the numbers. The American Heart Association (AHA) formulated guidelines on preventing heart disease and stroke in women as early as 2004 (see chart). According to the AHA, you can greatly reduce your risk for these diseases by maintaining certain body measurements and levels of cholesterol and blood pressure.

For further readings on this topic, here are two valuable resources: Center for Disease Control and Prevention, “Facts and Tools Every Woman Can Use,” www.cdc.gov/wisewoman/factsandtools.htm and National Heart, Lung, and Blood Institute, “The Healthy Heart Handbook for Women,” www.nhlbi.nih.gov/health/public/heart/other/hhw.