Women and heart disease

February is National Heart Month. This year, it’s time to ask the question: why do so many women die of heart disease?

People across the country are looking to win hearts this February, but it’s worth remembering the less romantic impact of heart health. After all, the consequences of a broken heart aren’t always down to forgotten Valentine’s gifts.

Cardiovascular disease is the number one killer of people in the UK. Every day, over 2.6 million people are living with coronary heart disease. Every seven minutes someone in the UK has a heart attack.

The male myth

In public discourse, heart-related issues are often framed as primarily affecting men. This isn’t always the case, however, and it could be having a negative impact on women’s health. Despite being responsible for one in four female deaths, the Centers for Disease Control and Prevention (CDC) estimate that almost half of women don’t identify heart disease as a risk.

The consequences of framing heart disease as a male-dominated issue becomes clear when considering the figures. Data collected by the American Heart Association in 2016 revealed that while 26% of women die within a year of heart attack, only 19% of men do so. These figures get increasingly worse as time goes on. Five years after an initial attack, almost half of women die compared to 36% of men.

Questions as to why this is the case have only recently surfaced on radio, television and in newspapers. Even then, it’s hardly been in the news longer than a day at a time. It’s certainly not given anywhere near the same publicity or press coverage as cancer. This has to change.

Coronary heart disease kills twice as many women as breast cancer. Worldwide, heart disease is the single biggest killer of women. And while this is surprising, what’s outright shocking is that in many cases, heart disease in women is preventable.

To fully understand the impact of heart disease, heart conditions and heart failures in women, we’ve done some digging to better understand the biology and risk factors, as well as looking at some potential solutions to this women’s health crisis.

Are women biologically susceptible to poor heart health?

Most of the factors related to poor heart health are related to environmental risk factors. For women, however, going through menopause can also increase the risk of heart disease. This is because estrogen levels drop significantly during menopause. The same effect can be seen when women have ovaries removed.

Estrogen is not only more prevalent in women than it is in men, but it also plays a major role in protecting women from heart-related ailments. From increasing the flexibility of blood vessels to enhancing the concentration of high-density lipoprotein (known as being good cholesterol), estrogen has a major impact on women’s heart health.

Ongoing studies are currently investigating whether hormone replacement is effective, but the consensus is that more research is needed. What is worrying, however, is that only 38% of studies investigating heart disease are populated by women.

Different sexes, different heart problems?

Women have different heart attacks to men. While men more often than not have a plaque rupture, women are more likely to have a plaque erosion, coronary vasospasm and spontaneous coronary artery dissection. Heart attacks are also more closely associated with hypertension in women, while diabetes is a bigger risk for stroke.

What are the risk factors for heart health?

According to the World Health Organisation (WHO), the following eight risk factors account for 61% of cardiovascular deaths and over three-quarters of all coronary heart disease:

  • Alcohol use
  • Tobacco use
  • High blood pressure
  • High body mass index
  • High cholesterol
  • High blood glucose
  • Low fruit and vegetable intake
  • Physical inactivity

In addition, there is also increasing evidence that connects psychosocial health, depression and high levels of stress to negative heart health outcomes.

Most of us understand that living healthily reduces the risk of disease and chronic conditions. None of these factors will likely come as a huge surprise. But whilst people of all sexes understand the need to eat better, increase physical activity and stop smoking, it doesn’t take into account most data suggests women live healthier lives.

According to the latest Office for National Statistics figures, 15.3% of women smoke compared to 19.3% of men. Likewise, while 62.8% of men drink every week, only 51.3% do so. In fact, women in the UK are healthier than their male counterparts across every factor stipulated on the WHO list.

When bearing this in mind, one has to question why women have such an increased risk of death from heart-related diseases.

Is there implicit sexism in the way women are treated?

Considering everything we’ve discussed so far, it’s difficult to see why more women suffer from heart disease. Yes, there is an increased risk when going through menopause, but it doesn’t tell the whole picture. In fact, some reports have suggested that a big part of the reason why women die from heart problems is related to sexism.

A recent article in Scientific American revealed that women who see male doctors whilst having a heart attack are 12% more likely to die of sudden death. Though there is no equivalent data in the UK, it’s still something worth considering. After all, only 45% of medical doctors in the UK are female. A 23% NHS gender pay gap is unlikely to shift the dial much either.

Another qualitative study worth considering was undertaken by the Yale School of Public Health in the US. It, like the study previously mentioned, also revealed that women are more at risk due to gender bias.

When most people think of a heart attack, they often think of a sharp, sudden pain in the chest. It’s what TV adverts and public information documents have always told us. For women, symptoms don’t always appear in such a way. And because of this misinformation, heart attacks can be misdiagnosed — increasing the risk of mortality for women.

How to improve chances of survival

Whilst much is made of technological and novel drug advances, the biggest impact being made to reduce heart disease in women is articles like this. Though we know our SRG blog doesn’t quite have the reach of a BBC Radio 4 programme or a Guardian article, it is content like this that can at least have some impact.

Through increased awareness and improved education, women will be less likely to play down symptoms — especially as most have no prior symptoms before experiencing a heart attack. Regular heart screenings are, therefore, also more important for women.

Whilst all of this sounds scary, the good news is that heart disease is often preventable. For women and men alike, making positive lifestyle changes can reduce the risk of heart disease.

By quitting smoking, sticking to recommended alcohol consumption levels, eating healthily, and maintaining a positive mental and physical wellbeing, the chances of experiencing the dreaded chest pain are massively reduced.

For more fascinating insights into the ever-changing world of the life sciences sector, stay tuned to all SRG Blogs.

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