Heart of the matter

Hands holding red heart

It's not surprising that many women in Australia believe their greatest health risk is breast cancer. That's why women are often surprised to find out that the single biggest cause of death in women in Australia is coronary heart disease. In fact, coronary heart disease causes more deaths in women than men in Australia. Cardiovascular disease (CVD) refers to all diseases and conditions involving the heart and blood vessels.

The main types of CVD in Australia are stroke, coronary heart disease and heart attack. Coronary heart disease occurs when the arteries in your heart (coronary arteries) become clogged with a fatty material called plaque, which builds up on the arteries' inner walls. Over time, if the plaque builds up too much, the arteries cannot deliver enough blood to the heart.

Coronary heart disease is usually the reason why a person has a heart attack, which happens when a blood clot partially or completely blocks the artery, reducing blood flow to the heart muscle.

And in Australia, this is more likely to happen to a woman than a man. Many people think of cardiovascular disease as something that mainly affects men. But this is far from the case. "A heart attack does not discriminate – it affects both men and women," says Angela Hehir, Manager of Women and Heart Disease for the National Heart Foundation Australia NSW Division. However, says Ms Hehir, only 36% of women recognise their risk of CVD.

Woman and man hiking outdoorsCVD and women

Ms Hehir says women's lack of knowledge of their CVD risk isn't surprising as, historically, women have been underdiagnosed with heart disease and underrepresented in research.

During a heart attack, women also tend to delay calling an ambulance or going to hospital, says Ms Hehir, most likely because they do not recognise their symptoms, which can be very different to those seen in a man's heart attack. "This is concerning, because the faster the medical treatment, the less heart muscle you may lose," says Ms Hehir.

The 'Hollywood heart attack', which shows a man clutching at his chest in pain, is not what a heart attack may look or feel like for a woman, says Jean Hailes for Women's Health endocrinologist, Dr Sonia Davison.

"Rather than the typical crushing central chest pain that is easily recognised as being due to lack of blood supply to the heart, women may have atypical symptoms," she says.

"These signs may include shortness of breath, back, neck and abdominal pain, indigestion, nausea or vomiting, palpitations and fatigue. Women also tend to seek medical care later and are usually older with other illnesses [such as diabetes or hypertension] when they first present with symptoms of CVD, compared with men." 

Women are also far less likely than men to have their heart disease risk factors measured by their GP, according to research by the George Institute and the University of Sydney. Increasing evidence suggests that unlike men, women may more often develop 'diffuse' plaque, in which fat deposits spread throughout the arteries, rather than build up in one spot.

Women may also be more prone to microvascular disease, in which small heart vessels fail to dilate properly. "In women, the risk of heart disease usually starts to increase from menopause, around the age of 50 years, when the arteries have become stiffer and other health issues such as hypertension and high cholesterol often occur," says Dr Davison.

"Recent research suggests that menopausal hormone therapy reduces CVD risk when used in women around the time of menopause rather than many years after menopause". 

Reducing your CVD risk

Ms Hehir says 90% of Australian women have at least one risk factor for heart disease and 50% have two or three. Some of these risk factors we can do something about, others we can't.

Risk factors we can't change include:

  • age (as we get older, our risk of developing CVD increases)
  • family history (if members of your family have had CVD, your risk is increased)
  • gender (males are at a higher risk of CVD, but once women reach menopause, their risk is equal to that of men)
  • ethnic background (people from some cultures, including Aboriginal and Torres Strait Islanders, are at greater risk.

Progressive plaque build up diagram

Risk factors we can change by altering our lifestyle include:

  • cholesterol levels (if yours is high, consider ways to reduce your cholesterol, such as dietary changes and physical activity – talk to your GP)
  • smoking (do not smoke! Smoking increases your chance of developing CVD as it narrows blood vessels, increasing blood pressure and forcing the heart to beat faster)
  • weight (if you are overweight, consider seeing a dietitian to discover ways to lose some weight)
  • physical inactivity (try not to sit too much during the day – get up and move!)
  • diet (consider eating a varied diet of healthy foods)
  • diabetes (if you have this condition, it's very important to reduce your risk of CVD)
  • blood pressure (if it's high, consider dietary changes, such as reducing salt, reducing your weight and alcohol consumption)
  • depression and social isolation (people who suffer from depression or are socially isolated have a greater risk of CVD).

The greater the number of risk factors you have, the greater the chance of developing CVD – so it is important to check and see where you are in terms of your risk of developing CVD. A heart health check tool is available for you to use. Better still – go to your GP for a heart check.

Eat like you're in Greece
Basket of fruit and vegetables

Research shows a Mediterranean diet, which is made up mainly of plant foods, legumes and olive oil, and a little fish and lean meat, can cut cholesterol and heart risks. You should also reduce intake of saturated fats such as cream and red meat.

These dietary measures help reduce unhealthy LDL (low density lipoprotein) and boost healthy HDL (high density lipoprotein). Aim to eat at least five serves of vegetables every day – this greatly reduces your risk of cardiovascular disease. Discuss with your doctor how often your cholesterol should be checked.

Sneaky heart risks

Even if you exercise and eat well for heart health, you could still be affected by these lesser-known risk factors for cardiovascular disease:

  • Sore and bleeding gums: mouth bacteria can cause inflammation that contributes to heart disease. So brush your teeth morning and night, floss daily and reduce your intake of sugary foods
  • Skimping on sleep: get seven to eight hours of sleep each night – this helps stabilise blood glucose, insulin and appetite hormones
  • Snoring: snoring may increase your risk of heart disease more than being overweight, shows research. Talk to your doctor about treatments
  • Depression: people with depression are twice as likely to suffer a heart attack, shows research from Concordia University. If you suffer from chronic low mood, try to exercise regularly, meditate and seek counselling. 

Know your numbers

That includes:

  • Blood pressure: normal BP is around 120/80. If yours is consistently higher – at 140/90 or more – it may be damaging your blood vessel walls. Have your GP check blood pressure at least once a year, or more often if you are experiencing problems
  • You can help minimise BP triggers: cut alcohol intake, exercise regularly, lose excess weight and consume less salt by eating fewer processed foods
  • Blood glucose: people with diabetes have a higher risk of narrowing blood vessels, heart attack, high blood pressure, stroke and other chest pain. To protect yourself against type 2 diabetes, eat foods with a low glycaemic index (GI). 

Read more about heart health and ways to reduce your risk of cardiovascular disease. 

This article was originally published in vol. 2, 2017 of the Jean Hailes Magazine.

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