Men or women - who has the higher risk of heart attack?

 

Heart disease is the number one killer of men and women across the world. Is heart disease a condition that women need to pay more attention to? And are symptoms of a heart attack the same in men and women?

"I see many men each year, to have their cholesterol and blood pressure checked and to assess their risk of heart disease, but I see less than half the number of women for this reason," says Johannesburg-based cardiologist Dr Tony Dalby. "Women are more familiar with the risk of uterine and breast cancer but are not aware of their risk of heart attack. Yet more women die of cardiovascular disease than die of cancer. We need to create awareness that women are not free of heart attack risk." In 2016 heart and artery-related claim pay-outs by Discovery Life were at 21% for women and 30% for men.

Discovery Life's claims data also shows that in 31-40 year-old-clients, one fifth (19%) of death claims are linked to heart and artery-related claims. Then, interestingly, a pretty consistent one third of deaths across the next three age bands are due to heart and artery conditions - for 41 to 50 year olds: 27% of deaths, for 51 to 60-year-olds: 29%, in the 61 years-of-age and older group: 29%.

Globally, CVDs are the number 1 cause of death

Over and above cancers, cardiovascular diseases (CVDs) are the number 1 cause of death globally. "More people die annually from CVDs than from any other cause. In America, Go Red for Women is the American Heart Association's campaign to raise awareness that 1 in 3 women will die of heart disease or stroke. 17.7 million people died from CVDs in 2015. That's 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke. "The incidence of heart attack exceeds that of stroke," explains Dr Dalby. "But, the two together have major impact on health and quality of life. And, it's clear that the South African incidence of coronary artery disease has increased across every population group."

What is a heart attack?

A heart attack occurs when the blood flow to a part of the heart is blocked. "Heart muscle dies without blood supply," explains Dr Dalby. This happens when coronary arteries that supply the heart with blood slowly become thicker and harder from a build-up of fat, cholesterol and other substances, called plaque. If the plaque breaks open and a blood clot forms, that blocks the blood flow and a heart attack occurs. The heart muscle damage increases the longer an artery stays blocked. Once the muscle dies, the result is permanent scarring. "With a scar in your heart, the heart doesn’t function properly and you may die at some future date from heart failure or from a sudden cardiac arrest."

Would you know if you had heart-burn, or if you were having a heart attack?

Crushing chest pain? That's what most people think they will feel if they are having a heart attack. But that's not always the case. "A heart attack may not be the worst pain ever," explains Dr Dalby. "Some patients do develop severe pain but more commonly the pain may seem bearable so that the heart attack can be misinterpreted as something else."

Generally, symptoms include:

  • an ache in the chest confused as indigestion or gas-like pain
  • an uncomfortable feeling in the centre of the chest and going into the arm, neck or shoulder
  • pressure or pain in the centre of the chest which may spread to either arm
  • upper back, shoulder, or throat pain
  • jaw pain or pain that spreads up to the jaw
  • breathlessness or fatigue
  • a pain in the tummy or the neck or teeth
  • discomfort in the stomach
  • breaking out in a cold sweat
  • nausea and shortness of breath
  • unusual fatigue lasting for several days or sudden severe fatigue, light-headedness
  • sleep disturbances
  • anxiety

"One of my lecturers at medical school said that any pain below the eyes and above the pubis can be a heart attack - and that applies both to men and to women," adds Dalby. Given, the array of possible symptoms of a heart attack, patients should recognize the substantial risks associated with heart disease.

Leading risk factors for cardiovascular disease

  • Do you smoke?
  • Are you diabetic?
  • Do you have high cholesterol?
  • Do you have high blood pressure (hypertension)?
  • Is your diet unhealthy?
  • Are you overweight or obese?
  • Are you inactive?
  • Are you consuming too much alcohol?
  • Have you had a previous heart attack, stroke or arterial disease?

These are the scenarios that raise your risk of heart disease. "Hypertension is a condition in which your blood vessels have persistently high pressure," explains Dr Deepak Patel, Clinical Specialist at Discovery Vitality. "A healthy blood pressure is 120/80 mmHg. If you have your blood pressure taken on three different days, and all your readings are 140/90 mmHg or higher, it is very likely that you have hypertension. The upshot of this is that your heart has to work harder to pump blood through your body." According to the World Health Organization (WHO), uncontrolled high blood pressure is dangerous because it can lead to stroke, heart attacks, heart enlargement, and eventually heart failure.

"When it comes to high cholesterol, we look particularly at low-density lipoprotein or LDL cholesterol levels. Ideally, if you are at risk of but haven't had a heart attack or cardiac event your LDL should be between 2.5 to 3 mmol/L. If you have had a cardiac event, then an LDL below 1.8 mmol/L is best," adds Dr Dalby.

Diabetics may have what are known as silent heart attacks - heart attacks without typical symptoms or pain. "A diabetic's prognosis after heart attack is generally not good - it's not death sentence but diabetes greatly increases the risk of future events. These patients need to take extra care and, in addition to managing their glucose, ensure that they have a healthy blood pressure, a very low LDL cholesterol, and do not smoke."

Why are more women under 40 suffering heart attacks?

Dr Dalby adds that, despite the protective effects of oestrogen against heart disease, there has been an increase in the prevalence of heart attack in younger women - under the age of 40.  "The reasons are not perfectly clear. "Women smoke more than they used to, while men have tended to reduce their smoking. Weight-gain is a major risk-factor for heart disease and women gain weight more easily than men so metabolic syndrome may play a role," he adds. "Diabetes also increases with weight gain and that is also a risk-factor for heart disease."

Hormone replacement therapy in post-menopausal women is associated with a slight increase in heart attack. "I discourage this treatment once the symptoms of menopause have settled," he adds. "The jury is also out on whether testing for and supplementing low testosterone levels in men has a protective effect against heart disease." 

Coronary artery disease, cardiac failure, cardiomyopathy and dysrhythmias are all heart-related conditions that are considered prescribed minimum benefit (PMB) chronic diseases. In 2015, these conditions accounted for 66 334 lives registered on schemes administered by Discovery Health's Chronic Illness Benefit. In 2016 the Discovery Health Medical Scheme paid out just over R5 billion towards cardiovascular health claims, also paying for 8889 angiograms, just over 110 000 ECGs (electrocardiograms, devices that check for problems with the electrical activity of your heart), almost 70 000 Stress ECGs and for the insertion of 3654 stents into people at risk of a cardiac event.

Why are there fewer women taking part in clinical trials on heart attack?

There's a perception that more research is done on heart attack in men. By Dr Dalby feels that this has not stood up to scrutiny. He's been involved in international clinical trials on heart attack for 20 years in which 75% of the patients are men. This may relate to willingness to take part or life-commitments and family responsibilities that make it harder for women to participate. Many treatment challenges relate to a person's size and the dosage they therefore need. Being physically smaller, women may suffer more side-effects of anti-platelet and anti-coagulant drugs than men, deterring them from trial participation. "With a lesser percentage of women on the trials, the data on what occurs is not always as strong as it could be," he explains. "But, in general, men and women respond to treatment similarly."

Takotsubo cardiomyopathy or 'broken-heart syndrome' and middle-aged women

"There are interesting relationships between stress and heart attack," explains Dr Dalby. So-called Takotsubo (or stress) cardiomyopathy is a temporary paralysis of a part of the left ventricle, the heart's main pumping chamber. This syndrome is named for the fact that a heart in this state resembles the tako-tsubo - a round-bottomed, narrow-necked vessel used in Japan to catch octopus. It's usually the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, a serious accident, or a natural disaster, severe pain, sudden blood pressure drops, domestic violence, an asthma attack, receiving bad news, unexpected loss, a fierce argument, intense fear, public speaking, a sudden surprise or more. This reversible condition occurs mostly in women. "Their coronary arteries are normal so something is happening in the heart muscle due to the adrenaline outpouring accompanying stress," explains Dr Dalby.

Live to prevent ever having to deal with CVDs

In one of the greatest ironies facing the planet, studies show that up to 80% of CVD-related premature deaths - 80% of the deaths attributable to the number one killer of people worldwide (in people under 65 years of age), are preventable through a healthy lifestyle.

From Discovery Health to Discovery Insure and Discovery Invest and to the new Discovery Bank (online in 2015), a shared-value insurance approach means clients are incentivised to lead a healthier lifestyle through Discovery Vitality - the science-based wellness programme that rewards healthy living both in the short- and long-term. Over the past 6 years Discovery Life clients who had a healthy lifestyle and engaged in the Vitality programme had a significantly lower risk of claiming that clients who did not lead a healthy lifestyle, and were rewarded through discounted premiums and more as a result. In fact, in 2016 highly engaged Vitality clients reduced their life cover claims by 61%.

It's important to know your health status.

Even if you feel fine, visit your GP or a clinic for a general check-up once a year, or book a Vitality Health Check to track your key health indicators on a regular basis. Taking steps towards prevention and early treatment of hypertension and other factors, will help ensure a healthier heart.

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