Don’t break your heart
Women and heart disease.
By Dr Karen Koch (mbchb) (cum laude)

Women are twice as likely to die from a heart attack than men. While men are twice as likely to suffer from heart disease as women, cardiovascular disease is still the number one killer in women. In South Africa, one in four women will suffer from a heart attack or stroke before the age of 60. Too often women don’t take their risk of heart disease seriously enough. It can be a fatal error.

What is heart disease?
The heart is a muscle pump responsible for the circulation of blood around the body. Without a functioning heart, blood cannot reach the organs with vital oxygen and nutrients. Your body (and moreover, your brain) cannot survive for longer than five minutes without circulation. The heart’s function in keeping the body alive is truly central to our health and wellness.
The heart muscle itself is supplied with blood by tiny blood vessels known as the coronary arteries. These small blood vessels can become narrowed and thickened in a process known as atherosclerosis. Atherosclerosis compromises blood supply to the heart muscle. The narrowed space within the blood vessels allows less blood to reach the heart muscle.
When this happens it is known as cardiovascular or “heart disease”. Heart disease usually shows itself in two possible ways:
• Angina: At first the compromised blood supply may only be noticed when the person tries to exert themselves. When the heart speeds up (e.g. when climbing stairs) a higher supply of oxygen is needed. The damaged blood vessels cannot supply this. The pain usually disappears when the person stops and rests. The heart becomes painful from the lack of oxygen. This is known as “angina”. Angina is a warning sign that there is underlying damage to the coronary blood vessels.

• Heart attack: A heart attack (myocardial infarction) occurs where blood supply to the heart muscle is completely cut-off, resulting in compromise and even death of part of the heart. Unless the blood supply is urgently restored, damage to the heart muscle can be permanent and fatal. Heart attacks occur in people with underlying damage to the coronary vessels, often where a clot completely eliminates blood supply.
What causes heart disease?
The underlying problem in heart attack and angina is “atherosclerosis”. Hardening and thickening of the blood vessel walls causes them to become narrowed.
Fatty deposits laid down in blood vessel walls usually start very early in life. Most people have small streaks of fat in their aorta – the main artery leaving the heart by the time they turn 10. Everyone has it to some degree by middle age.
Atherosclerosis is caused by many factors, but an unhealthy lifestyle is the single biggest cause of atherosclerosis. Atherosclerosis can also be worsened by conditions like high cholesterol, diabetes and high blood pressure.
Women are relatively protected from atherosclerosis until the time of menopause. Their risk of heart disease then massively increases.
Women in SA are also at higher risk of heart disease due to strong genetics which often play a role in its development.

Keep your heart in shape
In your 20s
Your lifetime eating and exercising habits are normally set during your 20s. Make sure they’re good ones.
Eat a diet low in saturated fat. Saturated fat is easily deposited on blood vessel walls leading to atherosclerosis. Saturated fat is found in animal protein such as red meat, processed and fried foods. No more than 25% of your total dietary energy intake should come from fat and less than 9% of this should be in the form of saturated fat, which sounds like a lot, but most of us are eating about 45% fat at the moment. Aim for low fat (less than 3g per 100g fat) or fat-free (less than 1g per 100g) foods.
Eat fresh fruit and vegetables. If you can get into the habit of eating fruit and vegetables every day you can slow down the ageing of your heart (and your skin). Try to prepare lunches for work at home as you’re more likely to include a healthy salad. Work on your menu ordering skills so you can still go out but do so while eating healthily.
Get active. Cardiovascular exercise such as walking, jogging, dancing and cycling exercises the most important muscle in the body – the heart. The American Heart Association recommends 150 minutes of activity in a week. You can increase your activity levels by consciously making an effort to exercise throughout the day. Speak to your doctor before exercising if you are very unfit, have underlying disease or suffer from chest pain.
Screening. About 20% of South African adults suffer from high blood pressure, 16% suffer from dangerously elevated cholesterol and 14% of South Africans suffer from diabetes. The majority of people with diabetes, high blood pressure and high cholesterol don’t feel a thing until complications occur. It involves a simple blood pressure or finger-prick test to check for these conditions. Speak to your Dis-Chem sister about getting these tests done.

Your 30s
Many women in their 30s are juggling family and work. Bad habits from your 20s can impact on your health in your 30s. Healthy eating during your 30s can ensure that you are not hit by lifestyle diseases early on in life.
Quit smoking. Smoking, even second-hand smoke is extremely harmful to the blood vessels. A smoker has two to four times the risk of having a heart attack as a non-smoker. Passive smoking increases your risk of heart attack by 50 to 60%. Quitting smoking can significantly reduce your risk of heart attack. Within 10 years your risk can reduce to that of a non-smoker.
Discuss your risks. If you are not certain about your risk of heart disease, speak to your doctor. Factors such as having many first-degree relatives who’ve had a heart attack or stroke, suffering from underlying conditions or following an unhealthy lifestyle could be increasing your risk of a heart attack.
Keep alcohol intake at a moderate level. The recommended alcohol limit for women is two units of alcohol per day. One unit of alcohol is the equivalent of 125ml wine, one tot of spirits or 325ml of beer. Drinking higher amounts of alcohol leads to elevated cholesterol levels and can increase your risk of a heart attack. Apart from cutting down on alcohol, drinking a glass of red wine as opposed to cocktails or white wine can also reduce your risk of heart disease. Red wine contains flavanoids – heart disease fighting antioxidants.
Maintain a normal weight. Being overweight, especially in the belly area increases your risk of heart disease, high blood pressure, diabetes and elevated cholesterol. Having a belly circumference more than 80cm in women and more than 94cm in men is also an indicator of increased risk of heart disease. Losing weight of 5 to 10% in obese individuals can reduce your risk of developing heart attack by up to 40%. Speak to your doctor about ways to lose weight if you are obese or suffer from underlying conditions.
Your 40s and 50s
Hopefully you have laid down the groundwork for a healthy lifestyle and can now reap the rewards. If not, don’t despair – it’s never too late to improve your health. Women in their 40s and 50s are at high risk of developing conditions like diabetes, high cholesterol and high blood pressure.
Reduce your salt intake. The recommended salt intake is less than 6g per day. Table salt is made of sodium chloride. Excessive salt intake can exacerbate your high blood pressure and lead to poor control. Most of us eat far above the recommended daily intake of salt – 3 to 4 times more than we should. Salt is used in most processed foods – not just salted foods, but any baked, fried, packeted or tinned foods contain additional salt. Just one teaspoon of salt is about 5g of sodium chloride. Learning to flavour food without salt and removing the salt cellar from the table will help you cut back on your intake.
Eat ‘good’ fats. Unsaturated fats are an important part of your diet. In particular omega-3 fatty acids have been found to reduce your risk of heart disease. Aim to eat 200 to 300mg of omega-3 fatty acids each day. Salmon, walnuts, flaxseed, leafy-green vegetables are all good sources of omega-3 fatty acids
Discuss Hormone Replacement Therapy (HRT). HRT was previously thought to reduce the risk of heart attack in women. Nowadays, doctors recommend that women who have had a heart attack or stroke avoid HRT. If you are taking HRT already, make sure you discuss your personal risks and benefits with your doctor.

Over 60
Women over 60 are at high risk of developing stroke and heart disease. It’s never too late to quit smoking, improve your diet or lose those extra kilos.
Go for a stress ECG. Apart from your regular screening, women in their 60s should have a full check-up with their doctor including a stress ECG. In this test you will need to walk along a treadmill or ride a bicycle while the doctor monitors your heart. Often this sort of testing can detect early heart disease.

Women and heart disease
As a woman it is important to understand that you are at risk of heart disease. Many women and even doctors don’t really believe this. Knowing your risk means you can take steps to live a healthier lifestyle, and go for regular screening to prevent or identify the condition.

What are the symptoms of heart attack?
Symptoms of heart attack or angina are experienced differently by different people. Most people will experience chest pain or discomfort in the chest. Many people describe the feeling as a “pressure” rather than pain on their chest.
The classic symptoms of a heart attack include:
• Pain in the neck, jaw, arm or fingertips
• Nausea
• Fatigue
• Shortness of breath
Unfortunately only 60% of women with a heart attack have typical chest pain symptoms. In fact, some people, especially diabetics experience no chest pain at all. The end result is that women are most often misdiagnosed. Women who do have a heart attack are more likely to die from their condition because of the atypical symptoms and the fact that the diagnosis is not considered.