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Her story: The heart of the matter

Actress AnnaSophia Robb walks the ramp at a fashion show in New York for The Heart Truth, a campaign to raise awareness of the risk of heart disease in women. (AP)

By 2015, India is going to be the capital of heart disease in the world. It is conventionally believed that heart disease primarily affects men. Incidentally, one woman in three has some form of heart disease.

Prevalence

Worldwide, 8.6 million women die from heart disease each year, accounting for a third of all deaths in women. Three million women die from stroke each year. Stroke accounts for more deaths among women than men (11% vs 8.4%).

8 million women in the US are currently living with heart disease; 35,000 are under age of 65. Four million suffer from angina.

42% of women who have heart attacks die within one year, compared to 24% of men.

Under age 50, women’s heart attacks are twice as likely as men’s to be fatal.

In India, nearly 3 lakh women die each year from heart attacks, which kill six times as many women as breast cancer. Another 30,000 women die each year of congestive heart failure, representing 62.6% of all heart failure deaths.

In our society, care towards women with heart diseases is far less as compared to their male counterparts. Women receive heart medicines like beta blockers, angiotensin receptor blockers and other important medicines less frequently. They are more frequently treated by indigenous therapy. This contributes to a higher rate of complications after heart attacks in women, Similarly, ladies with heart diseases are less treated by angioplasty and bypass surgery, and more by medicines.

In heart research studies, women’s enrolment is less than 25%. Therefore, the knowledge about nature of heart diseases, their treatment, therapy response and prognosis is being evaluated less.

At risk

71% of women experience early warning signs of heart attack with sudden onset of extreme weakness that feels like the flu, often with no chest pain at all. Medical professionals are challenged to respond to women’s milder symptoms, acting with insufficient guidelines.

Nearly two-thirds of the deaths from heart attacks in women occur among those who have no history of chest pain.

Smoking, diabetes and abnormal blood lipids erase a woman’s estrogen protection.

Women who smoke risk having a heart attack 19 years earlier than non-smoking women.

Women with hypertension experience a risk of developing Coronary Heart Disease 3.5 times more than that of females with normal blood pressure. High blood pressure is more common in women taking oral contraceptives, especially in obese women.

Smoking in women, especially in higher social class and in the very poor socio-economic group, is very high. It is far more than we anticipate.

Women with diabetes have more than double the risk of heart attack than non-diabetic women. Diabetes doubles the risk of a second heart attack in women but not in men. Diabetes affects many more women than men after the age of 45.

Obesity among women is approximately 32%. Obesity leads to an increased risk of premature death due to cardiovascular problems like hypertension, stroke and diabetes, coronary artery diseases.

Marital stress worsens the prognosis in women with heart disease.

Working women carry double stress at home and at work. Inability to cope with such double stress contributes significantly towards high blood pressure, diabetes and heart disease.

Compared to men

Men’s atherosclerosis plaque deposition occurs in clumps whereas in women athrosclerosis distributes more evenly throughout artery walls. This results in women’s angiographic studies being misinterpreted as “normal”.

Women wait longer than men to go to an emergency room when having a heart attack and physicians are slower to recognise the presence of heart attacks in women because “characteristic” patterns of chest pain and ECG changes are less frequently present.

In our society, family members are less prompt to take ladies of the family with suspected heart problems to doctors and hospitals. It has been observed in many studies that lady heart patients consult a heart specialist at a relatively late stage.

38% of women and 25% of men die within one year of a first recognised heart attack. Women are twice as likely as men to die within the first few weeks after suffering a heart attack.

46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years.

Women are 2 to 3 times as likely to die following heart bypass surgery. Younger women (40 to 59) are up to 4 times more likely to die from heart bypass surgery than men the same age.

Studies show women who are eligible candidates to receive life-saving clot-buster drugs are far less likely than men to receive them. Similarly primary angioplasty is less done for women.

Since 1984, more women than men have died each year from heart disease and the gap between men and women’s survival continues to widen.

Women receive fewer heart disease procedures than men, however, more is not necessarily better in this case and the best course of treatment for a woman with heart disease has yet to be established.

Women’s hearts respond better than men’s to healthy lifestyle changes, yet only 2% of the NIH (National Institutes of Health) budget is dedicated to prevention.

From our experience and data registry it has been observed that women of any age who are independent and support their family on their own are more responsible in following doctors’ advice , taking regular medication, attending doctors’ clinic regularly. They remain well as their therapy compliance is far better than their male counterpart.

Women of our society are far more responsible and caring about themselves. However, the social structure does not value the importance of early attention to a female heart patient right from a female child to an elderly lady.

In this Women’s Day weekend, our male-dominated society must learn how to respect the ladies of our society and value them and their illness with equal importance.

Solution

• Special Women and Heart Disease clinics or out-patient services in hospitals

• Fellowship training programme on women and heart disease during the post-graduate course in cardiology

• Social campaign and public awareness about importance of women with blood pressure and heart disease

The female child in every family must be cared for with equal opportunity and dignity. In our country, every homemaker, every lady employee deserves equal health care facilities with equal importance.

Conclusion

Women are the pillars of society. It is very important that ladies of our society must remain healthy. Heart disease in women needs special care. Women heart patients deserve special value and very special attention.

A healthy wife, a healthy mother makes a healthy family. Many healthy families make a healthy society. Many healthy societies make a healthy nation. Let us believe in the weekend of World Women’s Day that our women are our home, our nation.

The author is regional director and head of cardiology, Apollo Gleneagles Heart Institutes, Calcutta