WOMEN AND THE HEART…WHAT LURKS BENEATH? – Dr. Binoy John
Diabetes was associated with a higher risk of cardiovascular disease in women than in men with a three to seven-fold risk for developing blocks in the arteries of the heart in women in contrast to diabetic men who had only a two to three fold increased risk of blocks.
Obesity or a body-mass index (BMI) > 30kg/m2 is a strong predictor for the development of diabetes. Studies have shown that women with a BMI > 35 kg/m2 had a forty times greater risk for diabetes than women with a BMI < 23 kg/m2. It is also seen that visceral obesity with a waist circumference > 35 inches was associated with an increased risk for developing cardiovascular disease. Obese women had a 13% higher risk of death from cardiovascular disease compared to women with a normal BMI and life expectancy could be shortened by as much as seven years in obese women.
Physical-inactivity and a sedentary lifestyle are common in women in contrast to men and are risk-factors for cardiovascular disease with an inclination to develop diabetes, hypertension and obesity.
In contrast to men, women solely faced the travails of pregnancy. Women who develop high blood sugars during pregnancy (gestational diabetes) confront a life-long risk of developing diabetes and thus cardiovascular disease. Pregnant women are also predisposed to developing a condition called preeclampsia characterized by the triad of high blood pressure, water retention or swelling of the body and presence of protein in the urine. These women are at a three to six fold risk for the development of hypertension subsequently and a three to four-fold risk of developing diabetes. 1 in 4000 pregnant women also faced a risk of heart-failure of which 20% could die or could need cardiac transplantation.
Risk factors aside and coming to symptoms, women interestingly lack typical cardiac symptoms like chest pain and present more often with a typical symptoms, being easily ignored by the patient herself. More bizarrely, even if a woman had chest pain and other signs of reduced blood supply to the heart, but when investigated with a coronary angiogram, many of these women did not have any obvious blocks at all, a condition called cardiac syndrome X, which was also seen more commonly in women than men. In such patients, the blocks are located in the microscopic branches of the main arteries of the heart, not visible on angiograms, but resulted in microvascular dysfunction.