Heart Disease

We take our hearts for granted when we’re young. No matter what we do, our hearts just keep on ticking, pumping oxygen-rich blood to our cells and organs. But as we get older, many of us start to pay closer attention—men sometimes more than women.

A man’s story?

Up until fairly recently, when it came to heart health most of the attention seemed to be focused on men. Women’s major concern about heart disease was whether the men in their lives were at risk.

This attitude was well founded, since most medical research and guidelines around heart health centred on men. Five years ago, the Australian Heart Foundation launched its Go Red for Women campaign, which aims to increase awareness of women’s heart disease risk as well as encourage women to make healthier lifestyle choices to lower that risk.

Research on cardiovascular disease—and most other health issues—has traditionally involved primarily men. Some countries, including the US and Canada, have sought to address this disparity by passing legislation or issuing guidelines to increase the representation of women and minorities in clinical trials.

It seems, though, that research is still catching up: worldwide, women are still not included in enough mixed-sex cardiovascular trials to reflect the prevalence of the disease in women.

So what are the numbers for women?

While heart disease kills more Australian women than breast cancer, lung cancer and colorectal cancer combined, according to the Heart Foundation, only 36 per cent of Australian women are aware that heart disease is the leading killer of women.

Australian women are well represented in the statistics for heart disease and its risk factors:

• number 1—cause of death in Australia for women
• 1 in 5—Australian women have cardiovascular disease
• 3 times—more likely for Australian women to die from heart disease than from breast cancer
• 1 in 3—Australian women’s deaths are due to cardiovascular disease
• 90 per cent—of Australian women have one or more modifiable risk factors for heart disease:
  • 32.3 per cent are inactive
  • 19.5 per cent are smokers
  • 14.7 per cent have high blood pressure
  • 3.9 per cent have diabetes

The heart’s gender divide

When it comes to heart health in general, the gender divide is enormous. Not only are women under-represented in cardiac research, but, largely as a result, women often don’t recognise their risk of heart disease when associated with risk factors such as high blood pressure and high cholesterol.

Likely also a consequence of the dearth of research involving women and heart health, women are less likely to get treatment for heart disease, which is still largely perceived to be a man’s disease.

As a result, women are less likely to be admitted to intensive care treatment, cardiac rehabilitation programs or to receive interventions such as bypass surgery.

To learn more about why we may be so different—women versus men—in matters of the heart, we’ve compiled a list of areas in which our sex makes all the difference for our hearts.

Anatomy of the heart

It shouldn’t be a surprise, given the average woman is much smaller, proportionally, to the average man, that a woman’s organs may differ in size. The heart is no exception.

Men: An average man’s heart weighs about 315 g. The aorta (the artery that takes blood from the heart to the rest of the body) is wider in a large man—about 2.5 cm.

Women: A woman’s heart weighs about 265 g—50 g less than a man’s. The aorta in a small woman is narrower than a man’s—about 1.5 cm. In general, women’s coronary arteries are much smaller and lighter than men’s. Because of this, diagnostic and surgical procedures designed for men are more difficult and often less successful for women.

Cholesterol levels

Too much cholesterol in the blood is a major risk factor for heart disease. Excess cholesterol can settle on the inside of blood vessels, creating plaque build-up, which restricts blood flow, thus increasing the risk of a heart attack or stroke.

Men: Men’s cholesterol levels increase with age, as do women’s. But men’s levels tend to be higher than women’s until women reach the age of menopause. Recommendations for regular cholesterol level tests start at the age of 45 (or earlier if other risk factors exist).

Women: Before menopause, women’s oestrogen levels help protect them from heart disease by increasing HDL (good) cholesterol and decreasing LDL (bad) cholesterol levels. After menopause, however, women’s total cholesterol levels rise higher, in general, than men’s.

Heart rate

Heart rates for both men and women differ because of their sizes, but will also differ depending upon their level of athletic fitness. Someone who regularly engages in aerobic training will have a lower heart rate than that of someone who is sedentary.

The peak heart rate also differs for women from that of men. This is important not only as a measurement of exercise efficiency, but also as a tool to predict risk of heart-related death during a stress test.

Men: The peak heart rate for men is calculated by subtracting the man’s age from the number 220 (220 minus age).

Women: The peak heart rate for women is calculated by subtracting 88 per cent of the woman’s age from the number 206 (206 minus 88 per cent of age). This new formula for women changed only recently on advice from researchers following a large study involving 5437 healthy women ages 35 and older, which began in 1992.

Diabetes

Having diabetes—whether you’re a man or a woman—increases risk of heart disease because it increases other risk factors, such as high blood pressure, coronary artery disease and stroke, especially if blood sugar levels are poorly controlled.

Men: Men with diabetes have a greater risk of developing heart disease than men who don’t have diabetes. But women with diabetes fare worse.

Women: Women who have diabetes have a higher risk of heart disease than do men—almost 50 per cent higher. Although we don’t yet know why this is, researchers believe it may be associated with the fact that women are more likely to have more additional risk factors, such as obesity, hypertension and high cholesterol along with a possible disparity in treatment.

Metabolic syndrome

A group of health risks, including large waist size, elevated blood pressure, insulin resistance, low HDL cholesterol and high triglycerides, metabolic syndrome triples the risk of heart disease, stroke and diabetes.

Men: Men with metabolic syndrome have an increased risk of cardiovascular diseases, but less so than women.

Women: In women, metabolic syndrome seems to pose the most important risk factor for having heart attacks at an early age. According to a Harvard Medical School study of patients undergoing bypass surgery who also had metabolic syndrome, women were more likely than men to die within eight years.

Smoking

Although smoking is well known to pose a major risk for lung cancer and raises the risk for emphysema, stroke, infertility, reduced bone density and other forms of cancer, it is also a huge risk factor for heart disease.

Men: Among men who smoke and who also have high blood pressure and raised cholesterol levels, life expectancy from age 50 is 10 to 15 years shorter than men without those risk factors. But they still fare better than women who smoke.

Women: Women who smoke are 25 per cent more likely to have heart disease than men, according to a systematic review and meta-analysis of studies published between 1966 and 2010 undertaken in 2011.

Symptoms and warning signs

We’re all familiar, especially through media such as movies and television, with the classic chest-grabbing pain of a man undergoing a heart attack. But the truth, as usual, is more complex.

Many studies in the last couple of decades pointed to a substantial difference between men and women when it came to symptoms of heart attack. A large study published in 2009 established that women do experience the same heart attack symptoms as men, but also have additional symptoms.

Men: The range of symptoms for both women and men are somewhat similar, but additional symptoms may often appear in women. Typical symptoms for both men and women include:

• chest discomfort or pain
• arm discomfort
• shortness of breath
• sweating
• nausea
• indigestion-like symptoms
• clammy skin

Women: Although both men and women may experience typical or nontypical symptoms, women are far more likely to have additional symptoms including throat, jaw and neck discomfort.

While women may describe their pain differently than men, the most common symptom in women is still chest pain. The challenge is that women are less likely to believe they’re having a heart attack and they are more likely to put off seeking treatment.

Taking charge

There are some risks for heart disease that we can’t do anything about, such as our family history and our age. But there are plenty of risks that we can reduce, if not completely eliminate, by simply modifying some basic lifestyle choices.

If you smoke, stop.

Smoking or exposure to second-hand smoke increases our risk of heart disease by increasing blood pressure, building up plaque and blocking arteries and reducing oxygen in the blood. Once a smoker quits, heart disease risk diminishes.

• Within 48 hours of quitting smoking—heart attack risk begins to decrease.
• In the first year of being smoke free—the risk drops to half of what it was while smoking.
• Within five to 15 years—the risk becomes the same as for someone who never smoked.

Eat well.

It may taste good, but is it good for heart health? If what we’re eating is loaded with sodium or contains saturated or trans fats, and we don’t get enough fruits, vegetables, fibre and sources of heart-healthy omega-3 fats, we may be contributing to heart disease risk.

We can eat heart-healthy by

• eating a variety of at least 5 serves of vegetables and 2 serves of fruit each day
• consuming 25 to 30 g of fibre a day
• reducing fat intake to 20 to 35 per cent of total daily kilojoule intake
• choosing healthy fats such as those found in fish, seeds and nuts
• avoiding foods that contain white sugar and flour
• limiting tinned, packaged and processed foods to reduce sodium
• capping alcohol intake to 1 or 2 drinks per day

Get physical.

Because lack of exercise is associated with extra risk for heart disease, getting enough of it is critical. To make a difference, we should get a total of at least 150 minutes of moderate- to vigorous-intensity aerobic activity per week, in bouts of at least 10 minutes. In addition, we need strengthening exercises at least 2 days per week.

Getting physically active reduces the risk by

• lowering blood pressure
• increasing HDL (good) cholesterol
• reducing LDL (bad) cholesterol
• improving blood circulation
• increasing fat loss
• helping weight loss
• building muscle mass
• reducing stress

Talk to a health care professional before starting a new exercise regimen.

Reduce stress.

Though we all face stress in our lives, too much can be harmful to our health—and particularly to our heart. The exact link between heart disease and stress is still not completely understood, but it is known that people under stress may experience higher blood pressure and cholesterol levels. Research also points to a higher chance of developing blood clots. As well, someone under stress may be more likely to eat poorly, smoke and drink to excess as well as skip exercising.

The following suggestions may help counter the daily build-up of stress.

• exercise regularly
• try yoga
• take a walk in nature
• practise mindfulness
• soak in a warm bath
• seek out quiet
• laugh with friends
• avoid empty kilojoules and fast food fixes
• eat whole foods, unprocessed grains, fresh fruit, vegetables and lean proteins
• drink soothing herbal tea
• sleep well

Risk factors

Things you can’t change:

• family history
• age
  • men’s risk increases especially after the age of 45
  • women’s risk increases especially after the age of 55 or after menopause

Things you can change:

• smoking
• lack of exercise
• poor nutrition
• high sodium levels
• drinking too much
• being overweight
• high cholesterol levels
• high blood pressure
• diabetes
• high stress levels

Supplements for heart health

These are some of the best studied natural products to help support cardiovascular health.