Women And Heart Disease:

Ask any woman which disease she is most afraid of, and the reply you will usually get is "breast cancer". The reality, however, is very different; heart disease kills more women than any other disease. This comes as a surprise to most, as heart disease was always thought to be a "man's disease". In fact, women are as much at risk for heart disease as men are, but are protected by their hormones till they reach menopause. Cardiovascular disease is the leading cause of death among women, accounting for roughly one in three of all female deaths. Another sad statistic is that a much larger percentage of women die within one year after having a heart attack, as compared to men. The reasons for this are not well understood. One possible explanation is that women tend to get heart disease later in life and are therefore more likely to have coexisting chronic conditions. Women also tend to get less treatment than men, because they are typically not the main earning member of the family. This is seen all over the world, and in our country as well.

Some other little-known facts about women and heart disease are:

• Women who smoke have a 25% higher risk of developing heart disease compared to men who smoke, and continuous smoking can shave over a decade off a woman's lifespan.

• Women with diabetes have up to a two- to four-fold increased risk of developing heart disease compared to women without diabetes.

• Women are almost twice as likely as men to die after by-pass surgery.

• Women often do not have the typical symptoms of angina (chest pain radiating to the arms) or other symptoms associated with a heart attack. Therefore, they are often not diagnosed correctly and in appropriate time.

• Women are 20% more likely than men to die in the hospital following a heart attack.

• Women receive less aggressive treatment than men for their heart disease.

MENOPAUSAL HORMONE THERAPY (MHT):

One area of women's health which has perhaps generated the maximum amount of controversy and confusion is menopausal hormone therapy (formerly known as hormone-replacement therapy). Until recently it was thought that this therapy consisting of estrogen and progestin in varying combinations was protective for the heart. However, results from recent studies have contradicted these findings. The current scientific recommendations for hormone replacement are:

• This therapy should be started only after consultation with a physician, preferably the gynaecologist.

• Relief from the symptoms of menopause should be the primary reason for taking hormone therapy.

• Hormone therapy should not be used to prevent heart disease.

• Current cardiology guidelines indicate that MHT is generally safe and low-risk for cardiovascular events if started in healthy women under age 60 or within 10 years of menopause onset.

• Hormone therapies have been shown to help build stronger bones; however, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis.

Author: Dr. Aashish Contractor is India's pioneer in cardiac rehabilitation and the Founding Medical Director of the Mumbai Marathon. With over 25 years of experience, he has guided hundreds of heart patients to run safely.