Ischemic heart disease (IHD) or coronary artery disease (CAD) is common in India and a leading cause of death among the population. This disease is an outcome of atherosclerosis, or a hardening of the arteries, which results in reduced blood supply to the heart. It is characterized by the deposition of fatty deposits, called plaque, along the walls of blood vessels, making them narrower.
While women are also at risk of CAD, many remain unaware of this threat. Even though more women die from CAD than all cancers combined, diagnosis of CAD in women is often missed or delayed.
Risk factors
Several risk factors exist for the development of CAD in women.
Non-modifiable risk factors include:
- A family history of CAD.
- Age, since the disease is more common in the postmenopausal age group, perhaps as a result of depleting estrogen.
Modifiable risk factors include:
- High blood pressure: Blood pressure induces cell damage along blood vessel walls and increases the risk for CAD.
- Abnormal blood lipid levels: Elevated levels of LDL or bad cholesterol, and to a lesser extent y elevated triglyceride levels and low levels of high-density lipoprotein (HDL) cholesterol, contribute significantly to the development of CAD.
- Diabetes: A diabetic state is commonly associated with the presence of factors such as high blood pressure, obesity and elevated blood lipids.
- Obesity: Abdominal obesity (characterized by high waist-to-hip ratios) is associated with an increased risk of hypertension, diabetes and CAD.
- Physical inactivity: The risk of the occurrence of CAD is 1.5 – 2.4 times higher in those with sedentary lifestyles. This situation is noted increasingly in urban India where deaths from CAD are on the rise.
- Smoking: Smoking results in a hardening of arteries. Additionally, it induces blood platelets to stick together and form clots, which may block coronary arteries. It may also result in an arterial spasm, transiently reducing the passage of blood and oxygen through the heart. Smoking is also known to lower the protective or ‘good’ cholesterol (HDL) in blood.
CAD usually sets in about a decade later in women than in men, and occurs more frequently after menopause. Women are also twice as likely as men to die after a heart attack. The smaller coronary arteries of women are more easily affected by arterial disease as compared to arteries of men.
Symptoms
Women may suffer from both typical and atypical symptoms of CAD. Typical symptoms include chest pain or feeling of pressure in the chest.
Atypical symptoms, which can be misleading, include:
- Mild discomfort in the back, arms, neck, or jaw, with no associated chest pain.
- Breathing difficulty or breathlessness.
- Indigestion, heartburn, nausea, vomiting, or upper abdominal pain.
- Profuse sweating or cold, clammy skin.
- Dizziness.
Established diagnostic tests for CAD may provide inaccurate results in women. All these factors, combined with the false notion that women do not fall victim to heart disease, contribute greatly to delay in diagnosis and treatment.
Prevention and management
- Lifestyle: In order to prevent CAD, regular exercise is a must and maintenance of ideal body weight is essential. Healthy women should aim for a minimum of 30 minutes of physical exercise of moderate intensity, daily.
A diet rich in fruits and vegetables can also help lower the risk of CAD among Indians. Whole-grain, high fiber foods and fish in the diet also help. Also, smoking or tobacco use should be stopped completely.
Remember, even modest favorable changes in your diet, weight, and exercise level can significantly reduce your risk of developing CAD. - Regular checkup: An annual medical examination to check for risk factors such as hypertension, cholesterol and diabetes is important. Make sure your cholesterol, blood pressure and sugar are within safe limits.
- Treatment: Medication may be prescribed to prevent blood clots, reduce cholesterol, high blood pressure and elevated blood sugar, reduce workload on the heart and improve blood flow, and correct abnormalities in heart rhythm. Management of established heart disease involves procedures such as arterial stenting or coronary arterial bypass grafting surgery. The use of hormone replacement therapy in the prevention and management of this condition is controversial and its benefits are debatable.
The big, fat truth
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