Neena, a 49-year-old teacher and mother of three children, was always on the go, despite subtle hints from her husband and friends. Neena weight loss programme remained merely another New Year resolution. At her last annual check-up, Neena was diagnosed with high blood pressure and the doctor strongly recommended relaxation techniques. Not being one to unwind easily, Neena did not really follow-up on his advice. One Thursday afternoon, Neena was overcome with nausea. Attribting it to indigestion, she popped an antacid and kept going. The tightness in her chest got worse and her breathing got progressively more difficult. Within an hour, Neena was experiencing her first heart attack.
Today, with increased awareness about coronary heart disease and with improved medical technology at hand, go, simply because now we know a fatality can be avoided by dealing with it in time.
Heart disease is the number one cause of death among women in Western countries today, killing more women that all the caners combined. One out of every three women aged 40 and above can expect to develop heart-related problems sometimes in their lives, according to an estimate of people lifetime risk of the disease. While most women do not exactly make any effort to go to the hospital, a vast majority of them do ignore or suppress what their heart telling them, because they believe that women are not susceptible to heart attacks.
The incidence of heart disease in developing countries like India is also on the rise. According to a recent study, the prevalence of heart disease in women in New Delhi is about 10 per cent. The incidence of the disease rises dramatically after menopause. The mortality rate from heart disease in women in their 60s and 70s nearly equals that of men According to recent Yale University study in the US, women under the age of 75 are twice as likely as men to die after a heart attack.
High blood cholesterol, a condition where extra cholesterol in the blood collects in the inner walls of the arteries, preventing regular blood flow to the heart, greatly increase one chances of developing coronary heart disease. Blood cholesterol amongst women tends to rise from the age of 20, but goes up sharply at about 40. It continues to increase until the age of 60. studies have shown that more than half of women over 55 years need to lower their blood cholesterol.
Many have blamed the increase on the changing lifestyles and the new found liberalisation and the entry of MNCs into the economy. MNCs have changed our work ethic, with performance and output rating far higher than health and safety, explains Dr. Vishal Bali, centre manager of Wockhardt Hospital and Heart Institute, Bangalore, The sad part though, is that the MNC emphasis on health has not been brought in with the culture of workaholism,which makes every India executive a ticking time-bomb. Smoking, drinking and coffee add to the risk, with the average smoking executive running the risk of getting a heart attack 10-15 times higher than a non-smoker.
According to Dr. Vishal, the flip side of the issue is that with greater sections of the household budget being set aside for health each year, medical care facilities and centres are mushrooming across the country and companies tying up with them for annual check-ups. The cycle is vicious, with health care being made affordable by the very agencies that cause the problems but that a different story.
WHEN DOES CHD STRIKE?
According to Dr. Tripti Deb, senior consultant cardiologist with the Apollo Hospital, Hyderabad, women are by nature endowed with in-built protection against heart disease oestrogen hormones. Pre-menopausal women who are free from diabetes, are naturally protected from heart disease due to presence of this hormone. But those with diabetes are three times as prone to heart disease as a male patient of the same age.
Oestrogen helps prevent the buildup of bad cholesterol from rising in the blood. It also promotes good cholesterol and improves exercise capacity besides serving as anti oxidant to keep away the effect of a polluted environment.
Post-menopause, women are as equally prone to heart disease as their male counterparts. In the 30-40 age age group, women chances of being struck by the disease, depend on their rate of smoking, stress factors, lipid contents and genetic aspects.
WHAT CAUSE CHD
According to Dr. Vishal, smoking and the stress faced by corporate executives who are constantly pushed to perform better, are cause for a heart attack. consequently, the lifestyle generated by this stress engenders the disease : The four organs the kidney, lungs, liver and heart are interdependent on each other for keeping the pumping machine alive. A strain on either of these organs may cause a breakdown.
Genetics. Genetic propensity plays an important part in coronary disease, making men and women equally susceptible after a certain age. Genetic factors are especially relevant to India communities where consanguineous marriages are practised. According to Dr. Deb, the tradition was begun to safeguard the strength or so-called purity of the community and to ensure that the family money remained within its own circles. But in the process, the disease-causing genes have been multiplied instead of diluted through marriage and one consequently finds even nine-month-old babies, who are the off-spring of such marriages, with extremely high cholesterol levels.
Stress. Women today suffer from increasing stress levels as much as men do, whether employed or not. Many of my patients are housewives, who take on the burden of running the household all by themselves. Either the men are constantly travelling or live abroad, and bringing up the children and managing households, especially if it is a joint family, is no easy task. According to Dr. Deb, even women who live in nuclear families are subject to immense mental stress levels due to feelings of loneliness and a lack of support.
Exercise. The incidence of heart disease in women does not differ from that of men in theory, but it is made different by the natural difference between the two, explains Dr. Deb. Women, she point out, exercise far less than men do and the range of their physical activity is much less. Women traditionally do not lift heavy things around the house. A girl is discouraged from getting too interested in sport or physical activity, all of which contribute in some form or the other to the augmentation of the disease.
Fat. Doctor often shy away from performing by-pass surgeries on women, since they have to get through layers of fat in the chest India women, through their lack of physical exercise, accumulate fat in the chest area and this not only increases the chances of acquiring the disease, but also considerably reduces the rate of recovery from one. Abdominal fat is also extremely dangerous as it throws your entire system off balance, reducing the metabolic rate and inhibiting insulin production leading to diabetes and hypertension.
Physical structure.Women are generally more slightly built than men, and coupled with the lack of exercise from a young age, are equipped with thinner and smaller arteries. Consequently, the heart is less cable of bearing the extra load and needs acclimatisation to physical activity. In the case of a sudden block, a woman heart is unable to withstand the load, and consequently women succumb more easily to lesser strain.
Diet. Obesity is one of the most common cause of heart disease in women in south Asia due to an inadequate diet. The preference given to milk and milk products, an excess of carbohydrates, fats and refined products, without sufficient filling in with fibers and natural foods, is a major cause of coronary heart disease. Add to that, the cups full of sweetened coffee and tea, and the plethora of oily and fried products that South-Asian countries adhere to, and its a surprise we get away with just heart disease.
Awareness. Approximately 80 per cent of women are simply not aware that they are susceptible to heart disease, explains Dr. Deb, and it is only a question of raising the educational status of women that will make the difference. Women tend to ignore and suppress their feeling of pain or go in for self-medication, mistaking their symptoms for acidity or heartburn. Very often even ECG tests and stress tests are unable to provided an accurate picture when it comes to women, due to the levels of fat in the chest region.
It is essential that we give women the benefit of the doubt when they fall sick society tends to label them as being prone to emotional outbursts, and pays very little attention to their illnesses. While they take care of every one else, they neglect their own health. This has got to change, says Dr. Deb, adding that consequently, many women afflicted with heart disease die on the way to the hospital or in their sleep.
DO NOT IGNORE HEART-ATTACK BLUES
Treating clinical depression in coronary patients may mend their heart as well as their mood.
One of every five people who suffer a heart attack gets severely depressed. While that may seem unsurprising certainly a brush with mortality, being rushed to the hospital and having to take a buckeful of medications could throw anyone for a loop there growing evidence to suggest that something more complicated is going on. Men and women who have clinical depression, for example, are twice as likely to suffer a heart attack later on, while coronary patients who becomes severely depressed are three times as likely to develop further heart problem or die. Yet doctors often seem reluctant to treat depression in their heart-attack patients for fear that anti-depressing drugs might interfere with the cardiac medications.
Now comes word that at least one popular anti-depressant does not seem to make a heart condition worse and might even help to improve it. Researchers from the U.S., Canada, Italy and Sweden reported in Journal of the American Medical Association that sertraline, better known by the trade name Zoloft, caused no more complications in depressed cardiac patients than did a placebo. Indeed, patients on Zoloft experienced 20% fewer adverse cardiovascular events than those who took the placebo. One other advantage : unlike older antidepressants called tricyclics, Zoloft does not seem to cause irregular heartbeats. But the study, paid for by pharmaceutical giant Pfizer, make of Zoloft, included only 369 patients and so was too small to say for sure whether that apparent benefit was the result of a statistical fluke.
How might an anti-depressant make someone heart condition better ? Zoloft is one of a group of anti-depressants called selective serotonin reuptake inhibitors that work by keeping a neurotransmitter called serotonin from attaching to certain biochemical receptors in the brain. But serotonin receptors are also found in lots of other places. Blocking these receptors in bloodstream appears to reduce formation of artery chocking clots by preventing the aggregation of blood cells called platelets. In essence, SSRIS seem to perform double duty as mood lifters and blood thinners.
Just as important, treating depression in folks who have disease will probably make it easier for them to adopt healtheir dietary and exercise habits and follow doctors orders as they convalesce.
Plenty of questions still need to be answered. The study may have been too small to uncover all the drug to drug interactions with Zoloft, says Dr. Allan Jaffe, a cardiologist at the Mayo Clinic in Rochester, Minnesota, who wrote an editorial that accompanied the JAMA report. In addition, he says the patients did not receive the anti-depressant until one month after their heart attack, so it is unclear how safe it is immediately after wards. One thing is sure : if you have recently had a heart attack and are depressed, you are not alone. At least now there an anti-depressant that may be safe for your ailing heart.
RECOGNISING THE SYMPTOMS
Symptoms of heart ailment in a women are more subtle than a man and can lead physicians to explore other possible cause rather than a disorder of the heart.
Angina – tightness in the chest, sometimes radiating down the left arm or into the jaw is often mistaken for indigestion. Sudden pressure, squeezing or pain in the centre of the chest that lasts for a few minutes, goes away and then comes back.
Breathlessness or waking up at night having difficulty catching one breath.