HEART ATTACK…. COULD IT HAPPEN TO YOU?

If a woman has a heart attack, she’s more likely to die than a man. But why is this and how can we change that scary fact? Read on to find out…

How women need to wise up about heart health

Heartburn, a panic attack, menopause or even indigestion: women themselves and health professionals are likely to jump to the conclusion that one of these could be the problem, rather than suspecting for a moment that they might be having a heart attack.

According to the Bias And Biology report by the British Heart Foundation, coronary heart disease is still seen as a man’s illness, even though it kills more than twice as many women as breast cancer in the UK. This misconception is one of the contributing factors that mean two women a day die needlessly from heart attacks, or don’t recover as well as they could, because they are 50% more likely to be misdiagnosed initially and receive poorer aftercare and fewer treatments than men. ‘I’m shocked by this injustice,’ says cardiologist Dr Sonya Babu-narayan, associate medical director of the British Heart Foundation. She also explains that it’s not just the UK where this inequality exists; it’s the same in the US and Canada.

WHAT NEEDS TO CHANGE?

It’s a frightening thought, but being aware you could have a heart attack is the first step to staying healthy. ‘Recognising that it’s not just men who have heart attacks is critical,’ says Chris Gale, professor of cardiovascular medicine at the University of Leeds.

KNOW THE SIGNS

Latest research shows the most common symptoms in both women and men are the same: a sudden tightening in the chest, and squeezing central chest pain usually going into the jaw and arm. It might be severe or just uncomfortable. This has changed from the view that women’s symptoms were different.

DO MAKE A FUSS

Another, often fatal, difference is that men who think they are having a heart attack call 999. Generally speaking, women don’t like to make a fuss. ‘The main reason for this is unawareness that she may be having a heart attack,’ says interventional cardiologist Dr Ghada Mikhail of Imperial College Healthcare NHS Trust. ‘If a man is getting chest pain it’s the woman who usually insists he calls an ambulance. If it’s the other way round, her husband won’t necessarily push her to get emergency help.’

DELAY COSTS LIVES

Getting to a heart attack centre with a cardiac catheter lab, rather than A&E, is key. Blocked arteries need to be quickly opened up, restoring blood and oxygen to the muscle of the heart, explains Dr Mikhail, who is regularly on call at Hammersmith Hospital. ‘It all starts with the woman herself,’ says Dr Mikhail, who wants women to know it is not just a man’s disease and have the confidence to say: ‘I think I might be having a heart attack.’

DE-AGE YOUR HEART

High blood pressure, diabetes and smoking increase the risk of coronary heart disease for everyone, but latest research shows they pose an even greater risk for women. Other risk factors are lack of exercise, high cholesterol, obesity and a family history of coronary heart disease. If you had diabetes or

pre-eclampsia during pregnancy, you need to take extra care.

‘We can modify and reduce most risks; the one thing that we cannot change is family history,’ says Dr Mikhail, who wants younger women to make lifestyle changes to reduce their risk of developing heart disease when they are older. This is because once women reach the menopause they lose the protective effect of the hormone oestrogen.

Looking after your heart is good for your brain, too, as it lessens the risk of vascular dementia. If you’re over 40, use your free NHS health check: fewer than 50% have taken up their invitation. Check your heart age now at bhf.org.uk/informationsupport/ risk-factors/check-your-heart-age.

THE RIGHT TESTS

In the context of a heart attack, while an ECG can indicate that a coronary artery

is totally blocked, it is less good at identifying partially blocked coronary arteries, which are more common in women, says Professor Gale. Another check is to use a blood test to measure levels of troponin, a protein released into the blood after the heart is damaged, but lower levels in women may not be picked up. A study by the University of Edinburgh showed that a new, more sensitive test will double the number of heart attacks detected in women, but it is only in use in some hospitals. A collaboration between the NHS, government and industry aims to improve that, says the BHF.

A further factor in the gender bias is that fewer women take part in medical research trials so tests and treatments are based on data from men, though that is changing. For information about trials, visit nhs.uk/conditions/clinical-trials.

KEEP ASKING QUESTIONS

So, how can women be sure they get the right treatments? Professor Gale says, ‘Have the confidence to ask questions. Challenge me. Nowadays medicine is a partnership between the healthcare professional, the provider and the patient. It’s really important to ask why you're being offered certain advice, treatment or medication.’

He acknowledges that science may not have the answer yet. ‘Although younger women with heart attacks more frequently have arteries that are only minimally blocked, we’re not fully sure how best to treat this, but research with international trials is currently taking place.’

The BHF aims to raise £100m each year for research into heart and circulatory disease. For more advice, visit bhf.org.uk/women