Cardiovascular Diseases (CVDs), an umbrella term for diseases of the heart and blood vessels including heart attack, stroke, and heart failure, are the leading cause of death globally and account for 30 per cent of deaths in Jamaicans.
Countries throughout the Caribbean have high rates of cardiovascular risk factors such as high blood pressure, diabetes mellitus, high cholesterol and obesity, which drive the increasing prevalence rates of these life-threatening cardiovascular diseases. Heart disease risk factors are increasingly prevalent not only among adults but also among adolescents and children. In 2017, 30,000 children in Jamaica, between the ages of 10 and 19 years, had been diagnosed with hypertension.
Cardiovascular disease and COVID-19 are often referred to as a twin pandemic. Early in the COVID-19 pandemic, it was clear that patients with COVID-19 and cardiovascular risk factors or established cardiovascular disease had worse clinical outcomes.More recently, the long-term extrapulmonary impact of COVID-19 has become increasingly evident with increased rates of new-onset diabetes mellitus and heart failure being observed among persons who have had COVID-19 disease. Early diagnosis and aggressive management of cardiovascular risk factors and disease are key if we are to stymie our current explosion of cardiovascular morbidity and mortality.
WOMEN … LISTEN UP!
Heart disease can affect any one of us. If you are a woman, or care for one, pay close attention, heart disease is not solely a man’s disease. Heart disease is the leading cause of death in women globally, claiming the lives of over seven million women every year. Heart disease and stroke cause one in three deaths among women globally each year – that’s about one woman every minute.
The Jamaica Health and Lifestyle Survey III Studydocumented higher prevalence rates of CVD risk factors among Jamaican women than among Jamaican men. With one in three Jamaicans over 15 years old being diagnosed with hypertension, the prevalence of high blood pressure among Jamaican females 15 years or older was found to be 35.8 per cent, compared to a prevalence rate of 31.7 per cent among Jamaican males 15 years and older. One in two Jamaicans (54 per cent) 15 years or older were found to have an elevated body mass index, with two thirds of Jamaican women being overweight/obese.
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Data from the American Heart Association show that women with diabetes mellitus have a 50 per cent greater chance of having a heart attack than men with diabetes mellitus. Also, depression in women is associated with an increased risk of developing heart disease. This association is not seen in men.
In addition to the traditional cardiovascular risk factors, certain diseases that affect only women, such as endometriosis, polycystic ovary syndrome, and pregnancy-associated diabetes mellitus and high blood pressure, are associated with an increased risk of coronary artery disease (CAD), the leading cause of heart attack. Endometriosis has been found to raise the risk of developing CAD by 400 per cent in women under age 40.
The warning signs of heart disease in women are often different from those in men. This makes it harder to diagnose heart disease in women. Researchers from Harvard have shown that many women do not experience the crushing chest pain that is a classic symptom of a heart attack in men. Women are more likely to report feelings of indigestion or gas-like chest pain. Some women may feel extremely tired or short of breath, or experience nausea or dizziness; other women may have no symptoms at all. Exercise treadmill testing, a test used to help diagnose CAD, has been shown to be less accurate in women, with a higher rate of false-positive and false-negative results. Women also have smaller coronary arteries than men and are more likely to have coronary spasm. This can make angiography, a procedure using X-rays and contrast dye to look at the heart’s blood vessels, more difficult to do.These factors often delay the timely diagnosis and management of women with heart disease and can contribute to poorer cardiovascular outcomes among women.Women are also less likely to receive the recommended treatment for certain heart conditions, and corrective procedures such as coronary angioplasty and coronary bypass surgery are sometimes more difficult to do.
Alarming, also, is research that has linked heart disease in women to dementia. According to the study, ‘Cardiovascular Disease and Cognitive Decline in Postmenopausal Women’, by Haringet al, published in theJournal of the American Heart Associationin December 2013, older women with a history of heart disease and heart-related issues are more likely to develop thinking and memory problems than those without heart disease. Females who survived a heart attack were twice as likely to experience a decline in their memory and cognitive abilities than other postmenopausal women without a history of heart disease.
PROTECT AND MINIMISE RISKS
Knowledge is power. Be informed and protect yourself. There are many misconceptions about heart disease in women, and they could be putting our women at risk. According to the Lancet Commission, cardiovascular disease in women remains understudied, under-recognised, under-diagnosed, and under-treated. The more information a woman knows about heart disease, the better chance she has of beating it. It is never too late to learn about your risk for heart disease and what you can do to lower your chance of developing it. You can help to protect your heart by adopting heart-healthy habits:
• Know your numbers and discuss with your doctor what your target numbers should be. You can greatly reduce your risk for heart disease by monitoring your health status and by maintaining a normal body weight and acceptable levels of cholesterol, blood sugar and blood pressure.
• Don’t smoke, actively or passively. Your chance of having a heart attack doubles if you smoke as few as one to four cigarettes per day. Even if you don’t smoke, regular exposure to someone else’s (second-hand) smoke can increase your risk of heart disease.
• Manage stress levels and treat depression by finding healthy ways to cope with stressors. Maintain a good support network and do not be afraid to reach out for professional help if you need it.
• Eat healthfully. There are several crucial ingredients of a heart-healthy diet – whole grains, a variety of fruits and vegetables, nuts, poly-and monounsaturated fats, fatty fish (such as salmon) which are rich in omega-3 fatty acids, and limited intake of trans fats, salt, and sugar. Read your food labels.
• Be more active. Get at least 30 minutes per day of moderate-intensity exercise, such as brisk walking. Fit activity into your life. Take the stairs rather than the elevator, do yard work or gardening, park farther from your destination and walk.
Identifying those at highest risk of heart disease and ensuring they receive prompt and appropriate treatment can prevent premature deaths. Every woman should make time for healthy lifestyle habits, including a healthy diet, physical activity and scheduling routine health screenings, which can detect potential problems early and may even save your life. Remember to check your heart, be COVID and heart-smart!
- Dr Marilyn Lawrence-Wright is consultant cardiologist at the Heart Foundation of Jamaica, and head of cardiology at the University Hospital of the West Indies/The University of the West Indies. Send feedback to email@example.com.