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Heart Attacks In Women – Your Questions Answered

Coronary heart disease kills twice as many women each year as breast cancer, yet is still seen predominantly as a ‘men’s disease’.

With women 50% more likely to receive a misdiagnosis, the need for better education is vital.

Here, leading OneWelbeck Consultant Cardiologist Professor Jamil Mayet lifts the lid on the myths surrounding heart attacks in women.

Heart attacks in women – a stealthy killer

Heart attacks are more commonly associated with men yet research shows that, each year, coronary heart disease (CHD)- the main cause of heart attacks – kills more than twice as many women as breast cancer does in the UK and remains the single biggest killer of women worldwide.

Despite this, women are more than 50% more likely than men to receive a misdiagnosis for a heart attack and there is pressing evidence to support the view that women wait longer in A&E, even when they are in severe pain, thanks to a gender pain bias.

With more than 800,000 women currently living with CHD across the UK and 4 women per hour being admitted to hospital following a heart attack, the need for better awareness is, quite literally, vital.

“Less awareness” leaves women “surprised”

Leading OneWelbeck Cardiologist Professor Jamil Mayet is particularly concerned about the lack of education and conversation surrounding this issue. 

“Women who have heart attacks often present later to medical attention than men because there is less general awareness that heart disease affects women,” he commented.

“As such, women are often surprised when they are told that they have had a heart attack as they are more likely to have unusual symptoms that they may not associate with their heart.” 

Professor Mayet, who specialises in coronary disease, the heart in hypertension and sports cardiology, is known for his expertise in assessing the heart during pregnancy and before operations. 

A former cardiologist to the England football team and various premier league football clubs, he is a prolific researcher lecturer and has published over 200 peer-reviewed publications on topics such as the development of new technologies to assess and treat conditions of the heart and arteries.

Believing that ‘to be forewarned is to be forearmed,’ here, he shares his insights on the most important factors women should know about heart attacks, including how to prevent and identify them.

Professor Jamil Mayet answers your questions:-

How do heart attack symptoms differ in men and women? What symptoms should women be aware of/ look out for?

Most patients who have a heart attack get chest pain, however women are more likely to experience other symptoms such as shortness of breath, nausea/vomiting, back pain, dizziness, light-headedness, upper back pressure or extreme fatigue.

Having said that, traditional symptoms of a pressure or tightness coming and going in the centre of the chest lasting several minutes, discomfort in one or both arms and/or the jaw also commonly occur in women suffering a heart attack.

Other signs such as breaking out in a cold sweat, nausea or light-headedness may also occur with the pain.

Are there more risks involved with surgery for women?

Some of the tests used to assess the heart perform less well in women and some of our treatments for the heart such as coronary artery bypass grafting and coronary angioplasty and stenting are less effective in women, probably because the coronary arteries in women are typically smaller than in men.

What age should women start monitoring their heart health? When is the best time to start screenings?

The fatty deposits that clog up our blood vessels which cause heart attacks and strokes occur throughout our life and early changes can be seen in the vessels of teenagers.

Ideally, we should be interested in our “heart health” throughout our lives and make healthy choices as early as possible.

Often good lifestyle habits slip when we start work and start families because our time becomes more pressured but that is a good time to take stock before bad habits get embedded.

Our cardiovascular risk changes with time so there isn’t one single time point to pick – the earlier we start to take an interest in our heart health, the better.

However, in women there is a step increase in cardiovascular risk at the menopause and if there hasn’t been as assessment prior to that, it is a good time to start.

Does perimenopause or menopause affect women’s heart health or risk of heart attacks? If so, how?

Women’s hormones provide some protection from cardiovascular disease in the pre-menopause years.

At the time of the menopause, this protection is lost and the cardiovascular risk rises and continues to rise thereafter with age. However, the menopause itself doesn’t cause cardiovascular disease. 

The is some evidence that the oral contraceptive pill increases the risk of heart attacks but it is typically used by young women whose baseline risk is usually very low so this increase in risk is very small.

The good news is that recent evidence shows that menopausal women taking HRT have no higher risk of dying from a heart attack than women who don’t take HRT.

Does having children affect women’s heart health or risk of heart attacks? If so, how?

The heart can be affected during pregnancy. Pregnancy increases the work that the heart has to do by about 50%.

Occasionally if there is a serious pre-existing heart condition, this can cause a problem. Very occasionally, pregnancy itself can cause heart disease and, in particular, weaken the heart muscle.

However, this is rare and the vast majority of pregnancies do not cause any cardiac problems.

It has been shown that the more children a woman has, the more likely she is to develop heart disease in later life but it is still uncertain what the cause of this is.

What changes in heart health and behaviour should women look out for?

As we all get older, it is increasingly important to be aware of the risk factors that can affect our chances of developing cardiovascular disease.

The more risk factors you have, the higher your chances of having a heart attack or a stroke. These include high blood pressure, a high cholesterol, smoking, diabetes, being overweight and not exercising enough.

How does genetic heritage play a part in women’s risk of heart disease or attacks?

 The genes that you inherit from your parents play a very important part in influencing your chances of developing heart disease.

It’s been estimated that in some cases this may double the risk. Ethnicity also importantly influences the chance of developing heart disease.

In particular, South Asian ethnicity strongly increases the chance of developing heart disease. African-Caribbean ethnicity is very strongly linked with high blood pressure and strokes.

Does this affect how much attention certain women should pay to their heart health? (ie. If a woman has a history of heart attacks in her family, should she get check-ups and screening more often than those who don’t?)

Although everyone should pay attention to their heart health, if a woman has a family history of heart disease it’s even more important to be aware and to seek advice about improving their heart health.

If a woman doesn’t know what her family’s heart health history is, is there something she can do (checkups, at-home resting heart rate tests, for example) to discern this?

She should make sure she knows what her blood pressure is, what her cholesterol level is and should check that she doesn’t have diabetes.

In her lifestyle she should avoid smoking, have a healthy diet and weight and exercise regularly.

OneWelbeck Heart Health Services

OneWelbeck Heart Health is based in Mayfair, London and offers several COVID-secure services, including remote consultations and heart health checks.

On site, the service offers a wide range of imaging, stress testing and non-invasive screening procedures to both Self-Pay and Insurance patients.

For more information about the treatments and screenings on offer, as well as conditions covered and consultant expertise, visit the website at: https://onewelbeck.com/cardiology/ .

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