The New Year may be over but family gatherings continue in most homes which are still in a holiday mood. But such carefree occasions can have deadly outcomes if the family members indulge in excessive eating of the wrong foods and continue with their sedentary lifestyles, especially, if they are obese, and their health system has been compromised by various non communicable diseases. While these adverse impacts affect both men and women alike, evidence has shown that an increasing number of women are now becoming vulnerable to heart disease.
The Sunday Observer spoke to Community Physician and Coordinating Officer National Hospital Sri Lanka, Dr Ramya L.Premaratne for her views on what makes women so vulnerable to heart diseases today, and what the Ministry of Health is doing to lower these risks.
Excerpts…
Q. As men and women continue to enjoy holiday parties even though the New Year is over, reports of more women being admitted to hospitals with cardiac problems has raised concern among our health officials. Studies have shown that any festive season is likely to expose women in particular to heart disease. Do you agree?
A. Yes. It could be a lack of knowledge on nutrition. Along with stress and unhealthy diets, they are prone to get heart disease through over eating during a festive season.
Q. Yet, despite the fact that heart disease in women is one of the commonest leading causes for morbidity and death, it is not fully understood by women yet, as being a serious issue . What is heart disease?
A. The most common cause of heart disease in men and women is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease, and it happens slowly over time. It is the major reason for heart attacks.
Q. Do you have any figures regarding heart diseases among women in Sri Lanka? Apart from hospital figures and limited studies, has there been a national survey on this?
A. A higher prevalence of cardiovascular diseases were observed with age in men and women as expected, and the highest prevalence was observed in the age group of 60-69, with a predominance in males (14.6%) over females (9.8%).
Q. At what age are women more vulnerable to heart diseases today compared to the past?
A. Cardiovascular disease develops 7 to 10 years later in women than in men and is still the major cause of death in women over the age of 65.
Q. Is it correct that younger women are now succumbing to the disease. Why?
A. Heart disease is often perceived as a problem strictly for the older population. However, it is more common in adolescents and young adults since recently as childhood obesity has become a global epidemic where 1 in 10 children are estimated to be overweight. Obesity can lead to precursors for Cardio Vascular Disease such as, dyslipidemia (high cholesterol), hypertension (high blood pressure) and type-2 diabetes, and metabolic syndrome.
Q. What makes women more vulnerable to heart diseases than their male counterparts?
A. Central obesity with an increase in visceral fat occurs in women more frequently after menopause. With a higher presence of comorbid risk factors and components of the metabolic syndrome in women compared with ageing men with the increasing incidence of obesity there is a parallel increase in the prevalence of type 2 diabetes. Women with diabetes are at a greater risk of cardiovascular complications than their male counterparts.
Q. Menopause- is it a contributory cause?
A. It is assumed that exposure to endogenous oestrogens (female hormone) during the fertile period of life delays the manifestation of heart disease in women. Menopause transition is associated with a worsening Coronary Heart Disease risk profile. Women with clinically manifest CHD are in general older than men, with a higher expression of cardiovascular risk factors.
Q. Today, the Lankan woman has a longer lifespan of 78-80 years while the life span for males is around 75 years. As they age they are also exposed to several non communicable diseases such as, diabetes, hypertension, cholesterol and stroke. Can these pre-existing conditions lead to heart diseases?
A. Having diabetes means you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. Diabetes is a major risk factor for the development of heart diseases with a higher incidence of Myocardial Infarction in patients with diabetes. Although the exact cause and mechanism of heart diseases progression in patients with diabetes has not yet been determined, the most recent studies postulate the higher incidence of myocardial infarction in patients with diabetes as attributable to increased coagulability. (clotting of blood).
Q. What about stress? Many women now work outside their homes juggling heir housework with their office work. All this puts a lot of pressure on them. Can this also lead to early heart diseases?
A. Yes. Emotional or psychological stress potentially contributes to heart disease in many ways, from influencing heart disease risk factors, to affecting the development of atherosclerosis (hardening of the arteries), to triggering heart attacks. Persistently elevated levels of stress hormones like adrenaline and cortisol lead to the formation of blood clots, which increases the risk of heart attacks.
Q. Does unhealthy diets such as over eating during family get together cause heart disease?
A. Overeating can set off more serious medical problems. Heart attacks and strokes tend to peak at this time of the year. An unusually large meal can increase levels of triglycerides; saturated and trans fats increase blood cholesterol and heart attack rates.
The so-called holiday-heart syndrome, marked by the abnormal heart rhythm of atrial fibrillation, can be brought on by over consumption of alcohol that can cause a stroke, heart failure, and other heart problems.
Q. What are the symptoms to look for in a person who may be having a heart attack?
A. Not all people who have heart attacks have the same symptoms or the same severity of symptoms. Some people have mild pain; others have more severe pain. Some have no symptoms, while for others the first sign may be a sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you’re having a heart attack.
Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that’s triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.
A heart attack occurs when the flow of blood to the heart is blocked. The blockage is often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal, but treatments have improved dramatically over the years.
Symptoms
A heart attack may cause various types of discomfort that are not generally perceived as ‘pain’ and are not necessarily in the chest. The discomfort may:
· Feel like indigestion
· May not be in a specific spot
· Be felt in the chest, the inner arm (especially, the left arm), the jaw or teeth, or other parts of the body
· Get worse with activity and subside with rest
· Come and go, and increase over time; each new pain recurs sooner, lasts longer and feels worse
· Be accompanied by sweating, shortness of breath or flu-like symptoms
Common heart attack signs and symptoms include:
· Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
· Nausea, indigestion, heartburn or abdominal pain
· Shortness of breath
· Cold sweat
· Fatigue
· Light headedness or sudden dizziness
Q. How soon should the patient be taken to hospital?
A. As early as possible. It is better to bring the patient in an ambulance. If not, keep the patient in a lying down position and turn to a side while transferring to the hospital. Don’t try to give oral fluids or foods.
A delay of even a few hours, could literally make the difference between life and death, or the difference between no heart damage and severe damage.
Q. Gaps you see in delivering efficient cardiac services to patients, especially, women?
A. The Government provides universal healthcare to its citizens, without gender discrimination. However, the increase in NCDs such as heart disease, diabetes, cancers are becoming more frequent as the population ages and would challenge the Government’s continued ability to deliver universal low-cost healthcare. In addition, there has been a rise in obesity in women which increase the risk of heart disease.
Steps have been taken to increase diagnostic testing and essential medicines for heart disease which are limited, and make available essential clinical investigation and medical equipment necessary to diagnose and manage heart disease which are frequently unavailable at primary and secondary care levels and low availability of essential medications for treating heart disease.
Q. Your message to women on heart care during family gatherings?
A. Reduce the risk of heart disease and stroke with healthy food choices and lifestyle changes. Eat nutritious, balanced meals in limited quantities. Be physically active. Manage your stress. Limit alcohol and wine. Eat protein-rich snacks. Say No to salty and sugary bites!
