HEART DISEASE

KNOW THE FACTS, REDUCE YOUR RISK

STORY / DR KATE MARSH

Heart disease is the single biggest killer of Australian women. In fact, women are almost three times more likely to die from heart disease than breast cancer.

Coronary heart disease (CHD), stroke and other heart diseases, known collectively as cardiovascular disease, are the three leading causes of death among Australian women. Yet many women do not recognise they are at risk.
Despite this, most Australian women (more than 90 per cent) have at least one modifiable risk factor for CVD and half of us have two or three risk factors. These include not eating enough fruit and vegetables, being physically inactive, carrying excess weight and having high cholesterol levels.

A serious matter

The major cause of heart disease is a build-up of fatty material inside the artery walls, known as atherosclerosis. These fatty deposits gradually clog up the arteries, reducing blood flow to the heart. A similar process can occur in the blood vessels to the brain, and is the major cause of stroke.
Your heart muscle needs a constant supply of oxygen to do its job of pumping blood around the body. It gets oxygen from the blood, which flows to your heart muscle through arteries on its surface, known as the coronary arteries. When there is narrowing or blockage of these arteries, blood flow and oxygen to the heart is reduced, causing angina or chest pain, or the flow may completely stop, resulting in a heart attack. If not treated quickly, this can result in permanent damage to the heart muscle.

Under recognised and undertreated

Despite being the number one killer of Australian women, heart disease is often less recognised than it is in men and can be undertreated in women.
Why? Despite its prevalence in women, heart disease is still often seen as a disease of the opposite sex. This means that many women themselves do not realise they are at risk, and some health professionals are less likely to check for heart disease in women. The symptoms of heart disease can also be different in women, who are less likely to experience the typical chest pain that most men have when they experience a heart attack. In fact up to 40 per cent of women do not experience any chest pain. And, perhaps for this reason, women are less likely to seek help quickly.
Instead women may feel breathless, dizzy and/or nauseous, have pain, pressure or tightness in the neck, arms and jaw, and/or feel generally unwell.
If you experience any of these symptoms, it is important to seek medical help. If your symptoms are severe, getting worse and/or last longer than 10 minutes, call an ambulance.

Are you at risk?

There is no single cause for heart disease but there are many risk factors that increase your chances of developing it. Your risk increases with each additional risk factor that you have, so knowing your risks and taking steps to reduce as many as possible is important.
These risk factors include:
• Age
• Family history
• Ethnic background
• Smoking• Being overweight
• Being physically inactive
• Eating an unhealthy diet
• Having high blood pressure and/or high cholesterol
• Having diabetes
• Social isolation and depression

Fortunately many of the risk factors for heart disease are what we call modifiable – meaning that there is something we can do about them. And it mostly comes down to focusing on a few key healthy lifestyle habits, such as eating well, moving more and not smoking. Having regular heart health checks is also important.

Taking action – Seven steps to reducing your heart disease risk

There are a number of key lifestyle habits that can significantly reduce your risk of heart disease.
1. If you smoke, quit. This is one of the best things you can do to reduce your risk of heart disease, and improve your overall health.
2. Get moving. Schedule in regular exercise and incorporate more movement into your day.
3. Upgrade your eating habits. A heart-healthy diet is one that contains plenty of fibre-rich vegetables, legumes, fruits and wholegrains, moderate amounts of lean protein and healthy fats from foods like avocado, nuts, seeds and fish.
4. Manage your weight.
5. If you drink alcohol, do so in moderation. This means no more than two standard drinks per day.
6. Get enough sleep.
7. Take care of your mental health.

While heart disease might be the biggest killer of women, the good news is that reducing your risk is in your hands. Know your risk factors, be aware of the signs and symptoms and adopt the heart healthy habits above. There is no better time to take action than now.

Tracey: “My endocrinologist saved my life”.

Last year, after having had type 2 diabetes for almost 15 years, Tracey, 55, went to see a new endocrinologist following the retirement of her former specialist.
As part of her initial investigations, the endocrinologist, whom she now thanks for saving her life, recommended she have a stress test and referred her to a cardiologist. When the stress test showed a problem, and taking into consideration Tracey’s longstanding diabetes, being an ex-smoker, her age and family history, her cardiologist recommended she have an angiogram. With no obvious warning signs, Tracey was shocked when the angiogram showed two blockages and she was given the news she would need double bypass surgery.
In hindsight Tracey had been experiencing some shortness of breath when walking, but put this down to being less active in the months prior to her investigations. The possibility that there might be something more serious going on had not occurred to her as she has never experienced any chest pain. In fact, a little over a year earlier, she had completed a three-day, 51 kilometre hike in New Zealand, with no problems other than sore knees. While she knew that having diabetes and being an ex-smoker increased her risks, Tracey had not thought much about her family history despite the fact that her father had bypass surgery at the age of 50.
Fortunately, Tracey has recovered well and is now completing a cardiac rehab program at her local hospital, gradually regaining her strength. So what has changed since her surgery?
“I now try not to get too stressed. I am more conscious of this. And I’m getting out and exercising more and trying to get to bed earlier. I have lost weight and this also feels good,” Tracey said.

Anne: “I had a heart attack four days after giving birth”.

It is almost five years since Anne, now 49, had a heart attack just four days after arriving home following the birth of her second child.
While she did not have any prior warning signs, Anne did have a number of risk factors for heart disease including a history of insulin resistance, polycystic ovary syndrome (PCOS) and gestational diabetes in both of her pregnancies. But her diabetes and blood pressure were well controlled during pregnancy and her cholesterol had always been normal. The only clue was that her blood pressure was high following the birth, but this also happened in her first pregnancy and came back down within a few days so she was not too concerned.
The night of her heart attack, Anne had just put her kids to bed and was sitting down to relax in front of the television with her husband. The chest pain came on quickly and felt like she was being stabbed from the back. Her left arm also went numb and cold. Her husband called an ambulance which fortunately arrived quickly and Anne was able to be treated immediately. She was found to have three arteries with blockages and a tear in one of the main arteries to her heart. While one of her blockages was 90 per cent, it was too narrow to stent, so Anne was started on a number of heart medications, which she will take for the rest of her life, along with regular check-ups with her cardiologist.
When she returned home, Anne was anxious about resuming her usual activities. Due to having a newborn to care for she did not complete cardiac rehab until almost a year later, but in the meantime requested a stress test so she could see her limits. When she performed well on this, it gave her the confidence to get back to normal life.
“I had been told I was at higher risk [of heart disease] but thought this would be later in life. And I thought I was doing everything I could lifestyle-wise, to reduce my risk,” Anne said.
While the cardiologist and nurses were all surprised at what had happened, her endocrinologist wasn’t and later explained to Anne how her PCOS and insulin resistance had contributed to her heart attack. The good news is that her latest angiogram showed no signs of blockages and her torn artery has now repaired.

Resources
Heart Foundation Women & Heart Disease campaign: Making the Invisible Visible

Find out more about heart disease in women:
https://heartfoundation.org.au/campaigns/making-the-invisible-visible

Heart Foundation Mums United Campaign

Sign up for recipes and practical, low-cost tips for raising a healthier family:
https://heartfoundation.org.au/campaigns/mums-united

Your heart health check

Just like your pap smear, mammogram and other health checks, it is important to schedule in a regular heart health check with your doctor. This can be part of a normal check-up and should include:
• Discussing your family history of heart disease
• Having your blood pressure checked
• Having blood tests to check your cholesterol and blood glucose levels
• Checking your weight
• Discussing your lifestyle including what you eat, how active you are and your alcohol and smoking habits
• Discussing your mental health
This check can help you and your doctor to identify your personal heart disease risk factors and come up with a plan of action to reduce them.