Heart Disease

Women and heart disease

What is heart (cardiovascular) disease?

Cardiovascular disease affects either the heart or major blood vessels (arteries) supplying the heart, the brain and other parts of the body. It is the number one killer of both men and women in Australia.

What causes heart disease?

From early in life, fatty cholesterol deposits called plaque gradually build up on the walls of arteries. Over time this causes a narrowing of the arteries, resulting in reduced blood flow to the heart and other vital organs. These cholesterol plaques can rupture at any time and cause blood clots to form in the blood vessels which block the artery. This blockage of blood supply can lead to chest pain (angina), heart attacks and stroke.

What is a heart attack?

When an artery to the heart becomes completely blocked, an area of heart muscle is starved of oxygen and consequently dies.

Symptoms of a heart attack

Symptoms include lasting, severe, central chest pain and sometimes pain spreading down the left arm or into the jaw. Anyone experiencing this should go to hospital immediately, or call an ambulance, as early treatment for heart attack can save your life. Even mild chest pain, breathlessness or bouts of unexplained indigestion should be discussed with your health practitioner to ensure that these symptoms are not indicating underlying heart disease.

What is a stroke?

A stroke is the blockage or rupture of a blood vessel in the brain, causing damage to surrounding brain tissue.

Symptoms of a stroke

Stroke symptoms depend on which area of the brain has been affected, and can include severe headache, dizziness and confused speech. A stroke often occurs without warning, and weakness or paralysis down one side of the body, loss of speech, loss of swallowing reflex and sometimes unconsciousness may result. Hospital or ambulance treatment is urgently required.

What are the major risk factors for cardiovascular disease?

  • High blood pressure
  • Elevated blood cholesterol
  • Family history (if the relative was under the age of 65 years when the cardiovascular disease developed)
  • Cigarette smoking
  • Diabetes
  • Excess body weight, especially when abdominal fat is increased
    Lack of exercise

High blood pressure

Blood pressure is classically provided as two values, the systolic or upper level and the diastolic or lower level. Put simply, when the heart pumps, roughly every second it momentarily increases the pressure in the blood vessels (the higher systolic pressure). Then in the brief pause between the heart beats the pressure falls again (the lower diastolic pressure). Ideally blood pressure should be 130/80 or below most of the time. Blood pressure does fluctuate, but consistent higher levels can damage artery walls and the heart itself, increasing the risk of cardiovascular disease, especially stroke. Apart from family history, risk factors can be improved by healthy nutrition and lifestyle. Have your blood pressure checked regularly.

Elevated blood cholesterol

Cholesterol is the term used to describe the small particles that the human body uses to carry fats around in the bloodstream. Our diet contains cholesterol in animal products however we also make cholesterol from fat. The amount of cholesterol in our blood is not only determined by our diet (primarily our fat intake), but also by our family history via genetic influences.

There are several types of cholesterol. The low density cholesterol (LDL) has been labelled the ‘bad’ type as it tends to deposit cholesterol in unwanted areas, chiefly in the wall of the blood vessel leading to cholesterol plaques. The high density cholesterol (HDL) labelled the ‘good’ type, tends to carry cholesterol away from the blood vessel walls back to the liver for processing. The balance of these cholesterol types, as well as the total cholesterol level in the blood, is important.

So all people – even those with healthy diets and low body weight – need to have their levels checked regularly.

What are the symptoms of high blood pressure and elevated cholesterol?

Often none. This is why it is so important that all women over the age of 40 have blood pressure checks at least once a year and cholesterol checks as appropriate after discussion with your doctor. If your blood pressure or cholesterol is elevated then appropriate treatment is necessary to ensure the normal levels are maintained. Treatment of both these risk factors substantially reduces the risk of heart attack and stroke.

Factors that can influence high blood pressure

  • Family history (if the relative was under the age of 65 when the cardiovascular disease developed)
  • Cigarette smoking
  • Diabetes
  • Excess body weight, especially when abdominal fat is increased
  • Lack of exercise

What can I do to reduce my risk?

  • Enjoy a wide variety of healthy foods
  • Limit animal (saturated) fats as much as possible, e.g. choose lean cuts of meat, trim off excess fat, grill rather than fry
  • A little fat is okay – use mono unsaturated fats, e.g. olive oil for salad dressing and cooking
  • Choose calcium-rich, low-fat dairy products
  • Include phytoestrogen foods like soy products, legumes (chick peas, lentils, red kidney beans, etc.), rice, grains, nuts and alfalfa regularly in your diet
  • Eat fish high in omega-3 fatty acids twice a week
  • Reduce your salt intake
  • Maintain a healthy body weight
  • Avoid smoking
  • Exercise regularly – aim for 30-40 minutes of physical activity at least three times a week
  • Use relaxation techniques to reduce stress
  • Discuss medications for high blood pressure and high cholesterol with your health practitioner

What about supplements?

It is important to note that although ongoing studies with combinations of phytoestrogens, antioxidants and micronutrients are awaited with interest, there is insufficient data to recommend the consumption of isolated supplements for prevention of cardiovascular disease. In contrast, the consumption of diverse and balanced diets, which are rich in foods containing many nutrients, including antioxidants and phytoestrogens, can be safely recommended.

What about medications?

The treatment of high cholesterol and high blood pressure may require the addition of medications. These medications are introduced if lifestyle measures are not sufficient or levels are especially high. Treatments with blood pressure and cholesterol lowering medications have proved extremely effective in reducing all cardiovascular disease in high risk individuals but they need to be taken consistently.

Does hormone therapy (HT) have effects on cardiovascular disease?

Women taking HT (also known as hormone replacement therapy – HRT) appear to have a lower risk of heart disease, but there may be many reasons for this. HT, in tablet form, reduces cholesterol as well as having favourable effects on the blood-vessel wall. However, it also increases the risk of blood clots forming when blood-vessel plaques rupture. Currently HT should be avoided in women with established heart disease.