HEART DISEASE AND FEMALE-SPECIFIC RISK FACTORS

Heart disease is one of the biggest health challenges facing women today. It affects more than seven times as many Canadian women than breast cancer, yet many women are unaware that they may be at risk. This article discusses some of the general risk factors associated with heart disease, and takes a deeper dive into some that are unique to women.

Generally, when it comes to risk factors for heart disease there are two main categories to consider, those you can control and those you can’t. Factors like high blood pressure, smoking, diabetes, high blood cholesterol, obesity, and a lack of regular activity can be managed with lifestyle changes, and the help of your doctor. Factors like your age, ethnicity, and family history are risks you can’t change, but it’s important to be aware of them because the more risk factors you have, the higher the likelihood you will be affected by this disease.

For women, it’s especially important to understand that there are also some unique, or female-specific, factors that influence a woman’s cardiovascular risk. Among others, these factors include menopause, history of preeclampsia during pregnancy, and gestational diabetes during pregnancy.

MENOPAUSE

Much research indicates that your risk for heart disease and stroke increases after menopause. In pre-menopausal years, the hormone estrogen is protective of the heart. It relaxes the arteries and promotes good cholesterol. In post-menopausal years, however, estrogen declines and the emergence of cardiovascular risk factors such as high cholesterol and hypertension can appear. This has even been the case for some women who had normal or even low cholesterol and blood pressure before experiencing menopause.

PREGNANCY COMPLICATIONS

For most women, symptoms of preeclampsia will go away after pregnancy, but research suggests that it could have a more lasting impact on your heart health later in life. Preeclampsia can be characterized by pregnancy-induced high blood pressure. Studies show if you have a history of this condition during pregnancy you have double the risk of experiencing complications from a heart disease event, such as a heart attack or stroke, in the decades following the pregnancy. This risk is even higher if you have preeclampsia and miscarried, or delivered your baby prematurely.

Gestational diabetes is another pregnancy-related condition that could have an impact later in life. This condition occurs when you develop high blood sugar and other diabetes symptoms during pregnancy that weren’t present before. Some research suggests that if you have gestational diabetes, you are up to 70 percent more at risk of developing Type 2 diabetes later in life. Diabetes is itself a leading risk factor for heart disease. Studies also show that even if you experience gestational diabetes, but do not develop Type 2 diabetes, you may still have a heightened risk for heart disease in the future.

SYMPTOMS OF HEART DISEASE

Symptoms of heart disease vary, but some common signs can include:

• Chest pain and discomfort.
• Pain in the jaw, neck, throat, upper abdomen, or back.
• Shortness of breath during physical activity.

For women, however, symptoms may be different. Compared to men, women are:

• Somewhat less likely to experience chest pain.
• If they do experience chest pain, it doesn’t get better with rest, and it occurs routinely throughout the day, not just during exercise.
• More likely to experience symptoms that seem unrelated to the heart like nausea, vomiting, dizziness, fatigue, and stomach pain.

HOW HEART DISEASE IS DIAGNOSED

To diagnose heart disease, your doctor will likely start by asking you about your symptoms, when they began and whether anything makes them better or worse. You’ll also discuss your general health and lifestyle – whether you smoke, your activity level, diet, etc.

If you are a woman, this would be a good time to talk about whether or not you experienced any pregnancy-related complications such as preeclampsia or gestational diabetes. It would also be the right time to discuss menopause and whether your experience puts you at a greater risk.

You may be sent for blood work to determine factors like your lipid profile and complete blood cell count. Your doctor may recommend an arrhythmia monitor, electrocardiogram (EKG), or some form of cardiac imaging like an echocardiogram, cardiac MRI, or a stress test.

Cardiac imaging can assess the function, electrical changes, and/or blood flow of the heart. Mayfair Diagnostics offers a suite of cardiac imaging techniques including exercise stress testing, myocardial perfusion imaging and coronary computed tomography (CT) angiography.

Coronary CT angiography is available as a private pay exam, not covered by Alberta Health Care, at our Mayfair Place location. It can be purchased on its own or as part of a Health Assessment package, which provides a discount on multiple imaging exams when purchased together. It can be used to non-invasively examine the coronary arteries. Using a combination of X-rays and computer technology to produce comprehensive, detailed images, this exam can detect both calcified (hard) plaques and noncalcified (soft) plaques. Patients with family histories of heart disease may be at risk for developing atherosclerotic plaque buildup, blocking or narrowing arteries. On CT, these can be identified even before symptoms of chest pain develop.

Your health spending account or group medical insurance plan may cover the cost of a private CT that is prescribed by a qualified health care practitioner. You will need to check with your plan administrator for coverage details.

Whether public or private, medical imaging must be requested by a health care practitioner who will provide a requisition. A patient’s medical and family history, risk factors, and type and duration of symptoms, all affect a referring physician’s decision on which type of imaging is appropriate.

When we receive your requisition Mayfair Diagnostics will schedule your exam and provide you with detailed information to prepare for it. Once your exam is completed, your images will be reviewed by a specialized radiologist who will compile a report that is sent to your doctor.

REFERENCES 

Donnelly Michos, E. (2021) “Difficult Pregnancies and the Risk of Heart Disease.” www.hopkinsmedicine.org. Accessed May 11, 2021.

Heart and Stroke Foundation of Canada (2020) “Women’s Unique Risk Factors.” www.heartandstroke.ca. Accessed May 11, 2021.

Johns Hopkins Medicine (2021) “Traditional and Female-Specific Risk Factors that Influence A Woman’s Cardiovascular Risk (Webinar).” www.hopkinsmedicine.org. Accessed May 11, 2021.

Katella, Kathy (2020) “Heart Disease in Women: How Pregnancy, Menopause, and Other Factors Affect Risk.” www.yalemedicine.org. Accessed May 11, 2021.

Office on Women’s Health, U.S. Department of Health and Human Services (2019) “Heart Disease Risk Factors.” www.womenshealth.gov. Accessed May 11, 2021.

Sherrell, Z. (2021) “What are the Symptoms of Heart Disease in Women.” www.medicalnewstoday.com. Accessed May 11, 2021.