5 Heart disease risks in women

You may go for your routine cervical smears and mammograms but do you think about your heart health too? Coronary heart disease kills twice as many women in the UK as breast cancer, and it’s the single biggest killer of women worldwide. Yet it’s often considered to be a man’s problem.

According to a British Heart Foundation (BHF) report in October 2019, an average of 65 women die from coronary heart disease each day in the UK, most commonly due to a heart attack. Women don’t always realise they have a higher risk of heart disease, don’t always recognise the signs of a heart attack and often delay getting help. This is costing women’s lives.

You can’t change some of your risk factors, such as your family history or ethnic background. But it’s good to be aware of them. If you have African or African Caribbean heritage, for example, you may be more prone to having high blood pressure, which can lead to a heart attack or stroke. And there’s some evidence that the risk of having heart disease is up to 50 percent higher in South Asians (who are more likely to store excess fat around their waistline) compared to white Europeans.

“If you have heart disease in your family, consult your GP, who can advise on ways to reduce your risk of developing the condition through a healthy, balanced lifestyle,” says Dr Brian Clapp, consultant cardiologist for The Cardiac Clinic at London Bridge Hospital (part of HCA UK). “It is better to be aware of any inherited conditions as early as possible to better prevent problems occurring later in life.”

Here are five heart disease risk factors that are either specific to women or may affect women more than men.

1. Your hormones

Before the menopause, your oestrogen levels should help to keep your risk of heart disease low. But when you reach the menopause (around the age of 51), your risk of heart disease may rise. According to recent US research published in the European Heart Journal in March 2021, women’s blood pressure and ‘bad’ LDL-cholesterol levels often increase at the menopause, which may increase the risk of a heart attack. Autoimmune conditions (caused by an overactive immune system), such as thyroid problems, are more common in women than in men, and may make you more likely to have heart disease too.

“The female hormone oestradiol has a very protective effect on blood vessels and the heart,” says Dr Louise Newson, leading menopause specialist and founder of the balance-app.com offering free menopausal support for women.

“The risk of a heart attack in a menopausal woman is five times greater than the risk before her menopause. Women who take the right dose and type of HRT (containing oestradiol) have a lower future risk of developing heart disease and heart attacks. They often find their cholesterol lowers and their blood pressure reduces. Young women who have had an early menopause or premature ovarian insufficiency have lower oestradiol levels for longer, and have a higher risk of heart disease than women who experience the menopause at an older age.”

2. Your smoking habits

According to the BHF, smoking increases a woman’s risk of having a heart attack up to twice as much as a man’s. Giving up smoking is the single best thing you can do for your heart health.

“Smoking cigarettes makes the walls of your arteries sticky from the chemicals, so fatty material can stick to them,” says Julie Ward, senior cardiac nurse at the BHF. “If the arteries that carry blood to your heart get damaged and clogged, it can lead to a heart attack. If this happens in the arteries that carry blood to your brain, it can lead to a stroke. If you want to quit, get in touch with your local stop smoking services. You can also ask your doctor or pharmacist about nicotine replacement therapy (NRT) or medicines that can help you quit.”

The two-year Vesuvius study from the University of Dundee, published in November 2019 and funded by the BHF, suggests that vaping may be less harmful to your blood vessels than smoking cigarettes. “Women benefitted more than men in every subgroup we looked at when they switched from tobacco cigarettes to electronic cigarettes,” says Professor Jacob George, professor of cardiovascular medicine and therapeutics at Dundee and chief investigator of the trial.

“We are still trying to understand why this is the case, but we do know that women who smoke suffer ill-health in terms of cancer and cardiovascular disease disproportionately more than men.”

3. Your blood pressure

Research published in the British Medical Journal in 2018, by researchers at The George Institute for Global Health, University of Oxford, revealed that high blood pressure is more strongly associated with heart attacks in women than in men, though the reasons for this are still unclear. In August 2020, researchers at Queen Mary University of London, University of Barcelona and University of Southampton found that women’s heart muscle tends to be finer and smaller than men’s – more research is now needed to see how this could affect women’s heart health.

According to the Blood Pressure UK, six million people in the UK have high blood pressure and don’t know it. Yet every adult should know their blood pressure numbers in the same way they know their height and weight. An ideal blood pressure reading is between 90/60mmHg (millimetres of mercury) and 120/80mmHg. You have high blood pressure if your readings are consistently above 140/90mmHg.

“Dubbed the silent killer, high blood pressure rarely has symptoms,” says Katharine Jenner, CEO of Blood Pressure UK, “yet it causes 60 percent of strokes and 40 percent of heart attacks. Lifestyle factors, such as eating too much salt and not exercising enough, play a big part in raising your blood pressure. This means that most people can do something about their high blood pressure to bring it under control, and that’s why knowing your numbers is key.”

4. Your pregnancy history

Heart and circulatory conditions remain the biggest causes of deaths in pregnancy or childbirth in the UK. Women are most at risk of heart problems during or after pregnancy if they already have a heart condition. But according to the American Heart Association in March 2021, women who experience certain pregnancy related problems, such as pre-eclampsia, pregnancy diabetes or miscarriage, may be more likely to have heart disease, heart attacks and strokes in later life.

Professor David Williams, consultant obstetric physician at The Harley Street Centre for Women in London, says the heart has to work 50 percent harder and 20 percent quicker during pregnancy. “It pumps out more blood with each heartbeat,” he says.

“Women who become pregnant with a damaged heart that can’t meet the physiological demands of pregnancy can go into heart failure as pregnancy progresses. Women who develop high blood pressure in pregnancy, in particular pre-eclampsia, are cured in the short-term by childbirth. But they are at risk of developing high blood pressure in later life, and have a double risk of developing heart disease and heart attacks.”

5. Where you live and work

Around 11,000 heart and circulatory deaths are caused by air pollution every year in the UK. BHF research has found that tiny toxic particles, called PM2.5, can damage the heart and blood vessels. Polluted air can come from several sources, such as domestic wood burning and cars, especially diesel exhaust fumes, as well as industry.

Dr Mark R. Miller, research fellow at the Centre for Cardiovascular Science at the University of Edinburgh, says that women may be more sensitive than men to air pollution’s harmful effects.

“This is especially the case in many developing nations,” he says, “where women are traditionally the home keepers and are exposed to higher levels of pollutants from cooking and household heating using unclean fuels. The situation is less clear in Westernised nations such as the USA, Europe and the UK where some studies, but not all, find the deaths linked to air pollution to be greater in men. This may partially be due to there being higher levels of heart disease in men compared to women.”

According to the BHF, eating a healthy, balanced diet with plenty of fruit and vegetables may help to protect you from the negative impact of air pollution. Julie Ward says it’s also a good idea to check the air pollution levels in your area before you exercise.

“Avoid highly polluted areas, particularly if you have an existing health condition,” she says. “This includes roads with busy traffic, or places where air pollution is generated by industry, such as near factories. Some people choose to wear a mask to protect against the effects of air pollution but there is little evidence to say if this is effective.”

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