What Kills More Women – Tb, Heart Disease or Breast Cancer ?
Here’s a clue from the World Health Organization: “Widespread misconceptions persist about heart disease, often thought to be primarily a disease of middle-aged men. In reality, cardiovascular disease affects as many women as men, albeit at an older age. Many women still believe that they are more at risk from cancer than from heart disease.”
More alarming facts, from a leading cardiologist: “By 2015, India is going to be the world’s heart disease capital. It is conventionally believed that heart disease primarily affects men. Incidentally, one woman in three has some form of heart disease,” writes Dr Rabin Chakraborty, head of cardiology at Kolkata’s Apollo Gleneagles Heart Institutes, in The Telegraph.
Heart disease kills innumerable people. But it does not result in death alone. The majority of sufferers live on, troubled by the disease. In the case of women especially, they are often not treated or even properly diagnosed. According to one report, Indian women account for 15 percent of the global burden of heart disease.
Now for the answer to that early question: Cardiovascular disease kills more women globally than cancer, tuberculosis, HIV/AIDS and malaria combined. Moreover, women often face exclusive risks that may make them more vulnerable to heart disease and attacks.
Yet, the good news is that heart disease is preventable. Even if the disease progresses without a patient’s knowledge, there are often warning signs. Early diagnosis and treatment can also help patients lead normal lives, as Mumbai homemaker Geeta Valavalkar has been able to for over a decade.
One day in 2003, while on her morning walk in the park, Valavalkar felt a sharp pain in her left shoulder. The pain soon subsided and she decided to go about her chores.
But a few hours later, the waves of pain returned when she was out walking again, this time to see the neighbourhood dentist about a cavity. It was much worse than in the morning. Overwhelmed with nausea, dizziness and shoulder pain that grew more intense with every step she took, she felt too weak to move. Anyhow, her husband and son being away at work, she assumed it was spondylitis and got in touch with a family friend, an orthopedic doctor, who insisted she see a heart specialist immediately.
At Wockhardt Hospital soon afterwards, it became clear to the medics that she was having a myocardial infarction, a heart attack caused by the blockages—in Valavalkar’s case of three blood vessels to the heart. One of them, a key artery, had a 95 percent blockage. An angioplasty was performed and a stent inserted to open up the blockage. Her medical care had been so swift, however, that there was no serious damage to the heart muscle.
Since then she hadn’t been without trouble, but a cardiac rehab program she entered in 2006 has helped her lead a normal life. “I feel fine now,” Valavalkar says, looking back. “Periodic check-ups are essential and fortunately for me, these have revealed no problems. I am very active now. I even counsel other heart patients to help them stay positive.”
“Women have different risk factors for cardiac disease than men, but there is such little awareness,” says Dr Vanita Arora, cardiac electrophysiologist and associate director at the Max Healthcare Superspeciality Hospital in New Delhi.
Here are seven new facts about female heart attacks that every woman needs to know.
Early Warning Signs May Appear Months In Advance.
Studies in India, Canada, the US and elsewhere have all found that the majority of women report a number of key symptoms for as much as a year leading up to the attack. Most typically, these symptoms are unusual fatigue, sleep disturbances and shortness of breath. Others are anxiety, indigestion, periods of numbness in the arms and pain anywhere in the chest, jaw, back, arms or legs. Unusual fatigue troubled Valavalkar for weeks, but she did not attribute it to heart disease.
Standard Tests May Not Detect A Problem.
Reduced blood flow to the heart, called ischemia, has long been ascribed to the build-up of distinct blockages of plaque in the larger vessels feeding the heart. This is the cause of heart attacks in most men and women over the age of 75. But it is emerging that ischemia can have several causes, particularly narrowed or stiff tiny blood vessels of the heart that restrict blood flow, called coronary microvascular disease. “This is more commonly seen in middle-aged women,” says Dr V.K. Bahl, professor and head of cardiology at All India Institute of Medical Sciences (AIIMS), New Delhi. “And these abnormalities might not always show up on an ECG. These women don’t experience typical heart attack symptoms either. Today, there are more sophisticated scans such as the intravascular ultrasound and CT scans to better detect these conditions.”
A recent study, published in the Indian Heart Journal, found that up to 50 percent of the women with chest pain showed false positives on stress tests. Moreover, women who are hospitalized for coronary arterial disease (CAD) undergo fewer invasive procedures than men, a fact that may work against them. These findings may help explain why women are becoming the bigger victims.
Heart Attacks Are Increasing In Middle-Aged Women.
Due to the protective effects of estrogen, most women suffer heart attacks on average seven to ten years later than men, typically after menopause, with peak incidence, worldwide, after age 70. But studies show that in the last two decades, the number of attacks in women aged between 35 and 54 has been increasing. The shift may be related to increased incidence among women of the key risk factors for heart attack: Smoking, diabetes, high blood pressure, obesity and a sedentary life. “An urban lifestyle, career, severe stress, poor nutrition—all this has increased the risk factor tremendously, leading to more attacks at a younger age,” maintains Dr Bahl of AIIMS.
Women Have Unique And Significant Risk Factors.
Key risk factors for men and women are the same, but smoking and diabetes carry twice the risk of heart attacks for women than for men.
“And women have unique risk factors too,” says Dr Pratiksha G. Gandhi, chairperson of IPC Heartcare Centre, Mumbai. “Complications during pregnancy, particularly conditions that cause severe hormonal disturbances, like pre-eclampsia—high blood pressure and protein in the urine—substantially raise the risk of future heart disease. Other risk factors are the hormonal changes brought about by conditions like gestational diabetes and intrauterine growth restriction of the baby. Further, a condition called polycystic ovary syndrome, which causes infertility, weight gain and obesity as well as irregular menstrual periods, also raises the risk in women.”
Any patient who has undergone cancer treatments, such as radiation and chemotherapy, may be prone to cardiac damage as well. “Chemotherapy can weaken the muscles of the heart. As it cannot be avoided in some cases, it’s best to get a full heart evaluation done and take treatment for heart issues alongside chemotherapy, should the need arise,” says Dr Gandhi. “Though some factors that put women at risk to heart disease are not in their hands, women should focus on the factors that they can control, such as having a balanced diet, regular exercise, maintaining ideal weight and normal blood pressure and not smoking,” adds Dr Gandhi.
Broken-Heart Syndrome Can Be Life Threatening.
Japanese researchers in 1990 were the first to identify a life-threatening but temporary heart condition, often brought on by extreme stress, grief or shock, that is nine times more common in post-menopausal women than men. It is called “broken heart syndrome” or takotsubo cardiomyopathy, after the telltale ballooning appearance of the left ventricle.
The condition interferes with the effective pumping of the heart and can cause heart attack symptoms and ECG changes. But there is no artery blockage. The syndrome is being increasingly identified in patients and studies are underway worldwide to find its underlying cause. Right now, the best advice is to treat patients with standard heart medication and keep them in a hospital for a week. The abnormalities clear up between one and four weeks and most patients make a full recovery in two months.
A ‘SHORT-CIRCUIT’ LEADING TO ARRHYTHMIA CAN BE DEADLY.
This is another condition that women are more prone to than men. Anju Rehman, 39, of New Delhi was only 25 years old and five months pregnant with her first child when she experienced severe palpitations. The only warning sign she had both before and during these palpitations was severe shortness of breath. Admitted to a hospital, the doctors, finding nothing wrong, sent her home. After another episode in her eighth month of pregnancy, she was readmitted to another hospital, where doctors administered injections to stabilize her and sent her home.
Then, one day, after the birth of her baby, she woke up one morning, flushed and breathless. “Though my BP was normal, I could actually feel my heart racing,” she says. “I could barely breathe, felt very nervous and uncomfortable as if I were suffocating. I knew something was terribly wrong.” This time, she was admitted to the hospital for a week. An ECG showed her heart beating at the rate of about four times the normal rate.
“Compared to a typical heart attack, Indian women are more prone to a condition called cardiac arrhythmia,” says Dr Vanita Arora. “We know that a blockage in an artery can cause a heart attack, but few people know that attacks can occur because of an electrical disturbance of the heart, which disturbs the heartbeat.” Dr Arora explains that heartbeat can be irregular for many reasons, but a frequently identified cause is an ‘extra wire’ in the pathway of the heart, present from birth, which allows electrical impulses to travel along the heart too quickly, causing the heart to beat unusually fast. “Anju’s extra wire was burnt and now she is leading a normal life,” says Dr Arora. The incidence is much higher in the female population than in males, and the condition can show up any time after puberty. Hormonal changes, stress, anemia and thyroid issues can be triggers. “A persistent arrhythmia can be life-threatening,” warns Dr Arora. “This could explain many sudden deaths, especially among younger women.”
Believe In Your Symptoms And Be Your Own Advocate.
While understanding of heart disease in women has greatly improved in the last decade, cardiologists agree that more research and awareness is needed and women need to take their risks and symptoms seriously. Even a majority of the women who experience chest pain may tend to dismiss it, because they assume it cannot be a heart attack.
“It is safer and wiser to be alert to your own symptoms and have them checked thoroughly,” advises Dr Bahl.
“Don’t let anyone convince you that it is a panic attack or dissuade you from getting the help you need,” adds Dr Arora. “Listen to your body, believe in your symptoms and take action.”