INDIGESTION?
Doctors are finding that women’s heart attacks can be much less dramatic than men’s – which means our symptoms are easily misdiagnosed. Here’s what you need to know...
Or is it
something more serious…
It’s a bigger risk to your health than breast cancer
Surprised to learn this? We were, and we don’t think we’re alone. Two-fifths of women say they aren’t worried about heart disease, yet it kills more than twice as many as breast cancer and more than 900,000 women in the UK are living with it. What’s more, recent research found that women are 50% more likely than men to be misdiagnosed after a heart attack, and their long-term outcomes are worse. Why? Even medical professionals may be less likely to think of heart disease. ‘They may be more likely to attribute symptoms to something else at first,’ says Dr Sarah Clarke of the British Cardiovascular Society, ‘so it’s important that all women know the symptoms.’
Rapid diagnosis is crucial
‘Typically women will underplay their symptoms, especially if they are atypical, and attribute them to something else. This means that vital diagnosis time can be wasted and they take longer to get into the system. This leads to a poorer outcome,’ says Dr Clarke.
Swedish researchers found that many women reported delaying going to hospital or calling the doctor because they were busy looking after other people. While in a British Heart Foundation survey, almost a third of women who experienced unusual chest pain said they would go for a lie down. Over a fifth said they would just take indigestion medicine. Yet the longer a heart attack is left undiagnosed and untreated, the more the heart can be irreversibly damaged. A study
[continued from previous page] at Yale Public School of Health found that young women in particular may ignore the early warning signs of a heart attack – which could help explain why younger women are more likely to die of a heart attack than men of a similar age.
Younger women need to heed the warning signs, too
Forget the idea that heart disease is something that only affects older men and women in their 70s and 80s. It is more common in women as they age – before the menopause, women get some protection from oestrogen, but when levels drop, it can lead to an increase in cholesterol levels, and white blood cells becoming stickier and more likely to adhere to the inside of blood vessels. However, young women – even premenopausal women – can suffer, too. We know that conditions such as high blood pressure, type 2 diabetes and high cholesterol, all of which dramatically raise the risk of heart disease, are on the increase – and in a woman under 50, a heart attack is twice as likely to be fatal as in a man.
Pay attention to your family history
Exercise and a healthy diet will help protect you, but a family history of heart disease is as relevant for a woman as it is for a man. If you have a father or brother who developed the disease before the age of 55 or a mother or sister who developed it before 65, it significantly increases your risk.
Chest pain is only part of the story
We’re all familiar with the classic heart attack symptom of crushing, radiating chest pain, but women may have less typical and often less dramatic symptoms. ‘Women’s symptoms may be less defined – typically stomach problems, nausea and fatigue,’ says Dr Clarke. The result is that women’s symptoms may be missed or misdiagnosed. Researchers at the US National Institute of Health found that 95% of women experienced new or different physical symptoms as long as a month before they had a heart attack. Nearly 75% of them reported unusual fatigue, and almost half had sleep disturbances and shortness of breath. Symptoms may include one or all of these: ❖ Chest pain or discomfort ❖ Pain radiating to the arms, neck, jaw, stomach and back – for some the pain is severe, but for others just uncomfortable ❖ A feeling of indigestion or reflux-type pain ❖ Feeling sick, sweaty, breathless or light-headed with associated chest pain or discomfort ❖ A general feeling of being unwell or lethargic when accompanied by chest pain or discomfort.
Some women are more at risk than men
If you’re a smoker, you increase your risk of heart attack even more than a man does by smoking. And having diabetes increases the risk of heart disease in women more than in men – it doubles the risk in men but in women it increases it more than four fold.
Managing your stress is vital
Chronic stress could be as important as high blood pressure and smoking to your risk of heart disease, say researchers at Harvard
Medical School. They found that stress creates a constant flurry of activity in the amygdala, the area of the brain that processes emotions. This then sends signals to the bone marrow to produce extra white cells, which act on the arteries and cause inflammation. More research is needed but, as Dr Clarke points out, too much stress may have other consequences. ‘It means you’re more likely to be a couch potato, smoke and drink more – all of which increase your risk.’
Women are affected differently
Much of the current thinking about heart disease and its treatment comes from studying it in men. Researchers are only just beginning to uncover the biological and medical differences in women’s heart disease, and the differences in their responses to treatment. It’s becoming clear that women are more likely to develop problems in the microvasculature – the tiny blood vessels branching off from the larger coronary arteries. Heart disease normally develops because plaque forms in the main arteries leading to the heart. With coronary microvascular disease, the small blood vessels are damaged in a way that can cause spasms and decrease blood flow to the heart muscle. This can be more difficult to diagnose, as it’s not picked up by standard tests. ‘Women may have symptoms of heart disease even though their coronary arteries appear
The longer a heart attack is left untreated, the more the heart can be irreversibly damaged
[continued from previous page] normal and the underlying disease can go undetected for a long time,’ according to Dr Clarke. Disease in these smaller blood vessels can be detected on an MRI or by using a stress echocardiogram that uses ultrasound imaging to detect how effectively your heart is working.
And there may be other factors that make women different. Last year, researchers at University College London discovered a particular version of a gene that could increase certain women’s risk of heart disease and stroke – men didn’t seem to be affected in the same way.
Diagnosis may be different, too
A British Heart Foundation study found that a new high-sensitivity ‘troponin’ blood test could be vital in diagnosing heart attacks in women. When the researchers looked at 1,000 men and women admitted to hospital with chest pain, the more sensitive test doubled the diagnoses of heart attack in women.
Find out how you can protect yourself now
For an assessment of your real heart age and to get advice on lowering your risk of heart attack, visit The British Heart Foundation website at bhf.org.uk. Everyone over the age of 40 should be offered an NHS health check every five years. This is designed to spot early signs of heart disease, stroke, kidney disease, type 2 diabetes and dementia.
Researchers are uncovering differences in heart disease in men and women