WOMEN’S CARDIOVASCULAR HEALTH: GETTING TO THE “HEART” OF THE MATTER

BY DR. SHAHIN JAFFER MD, MHSc,FRCPC

Women face many inequities and challenges when it comes to heart and brain health. The 3rd annual Wear Red Canada Day, being held on February 13, 2021, aims to increase awareness and support women’s heart health and wellness. This article will promote an understanding of the higher risk of complications and death from heart disease in women, and provide information that is focused on the South Asian community.

Heart disease is the number one killer of women worldwide and it affects women of all ages. In Canada, heart disease is the leading cause of hospitalization and early death in women. One in 3 women will die as a result of heart disease or stroke. Despite this, women are under-investigated, under- diagnosed, under-treated, and under-studied when it comes to heart disease.

Early heart attack signs are missed in 78% of women. Both men and women suffer chest pain, but women have more accompanying symptoms than men such as shortness of breath, racing heart, upper abdominal pain, nausea, and unusual fatigue.

For symptoms and signs of stroke, one-sided numbness or weakness is present in both men and women. However, over 50% of women also had changes in mental status, either confusion or disorientation. Moreover, many women tend to delay seeking medical attention: young women take 9 hours to arrive at the hospital when having a stroke and for older stroke patients, including older women, it takes 7.5 hours to seek medical attention. These delays can result in increased permanent damage to brain cells and reduced chances for full recovery.

Here are some additional facts with regards to heart attack and stroke in women:

–           1/3 more women than men die of stroke

–           Women are 60% less likely to regain independence after stroke in daily activities compared to men & have a worse quality of life.

–           Almost twice as many women as men go to long-term care after their stroke.

–           Women are 5 X more likely to die from heart disease than from breast cancer.

–           Women who have a heart attack are more likely to die or suffer a second heart attack compared to men.

–           Women are 50% less likely than men to participate in cardiac rehabilitation.

–           Women with heart disease cope better through sharing of experiences and social support networks.

-If you experience any of the heart or brain signs below, call 9-1-1 immediately:

Heart attack: chest discomfort, sweating, nausea, shortness of breath, light-headedness.
Stroke: drooping face, inability to raise one arm or leg, slurred or jumbled speech.

South Asian Heart and Brain Health
South Asians are currently the largest visible minority in Canada. The burden of heart disease in this population is significant: both South Asian men and women have the highest risk of heart disease, high blood pressure and stroke when compared to Caucasians and other ethnic groups.  There is a 2-fold higher risk of diabetes, a 4-fold increased risk of heart attacks among South Asians. Strokes and heart attacks occur at an earlier age among South Asian men and women. South Asian women develop pre-diabetes and diabetes at lower body mass index and waist size when compared to other groups.

In all South Asians, 9 traditional risk factors contribute to increased risk for heart attack: high cholesterol, high blood pressure, diabetes, cigarette smoking, moderate alcohol use, physical inactivity, reduced consumption of fruits and vegetables, psychosocial stress and being overweight or obese.

Among visible minorities only around 50% are aware that most women have at least one of the above risk factors. South Asian women in particular are also less likely to have prevention education, assessment (seeing a health care provider) and treatment.

Women are under-represented in medical studies: less than 1/3 of stroke and heart disease clinical trial participants are women, even less so for ethnic and Indigenous groups. Low enrollment of women is most commonly due to gender-based issues such as familial responsibilities, cultural and socio-economic barriers, and difficulty accessing the study site.

Hormonal fluctuations that women experience pose unique cardiovascular disease risks. For example, high blood pressure and diabetes in pregnancy double the risk for cardiovascular disease during one’s lifetime. Indeed, experts regard pregnancy as a woman’s first “stress” test.

We know that heart disease is largely preventable in men and women – 80% of individual risk factors can be modified. Know your numbers for waist circumference, blood pressure, cholesterol and blood sugar. Reduce your risk by staying active (moving), maintain a healthy diet (avoid sodium (salt), reduce saturated and trans-fats), reduce weight if you are overweight or obese, stop smoking, reduce alcohol intake, limit stress and its impacts and get regular checkups with your physician.

In summary, heart disease is the leading cause of premature death in Canadian women and South Asians are at particularly high risk and experience worse outcomes. We call on all South Asians, male champions and women advocates, to join the campaign to improve awareness of women’s heart and stroke health for the benefit of all of us.  Get involved and wear red: a red shirt, red tie, red socks, red shoes, even red hair (henna) on Wear Red Canada Day on February 13, 2021. For further information, including a tool-kit and ideas for activities to promote women’s heart health at your workplace and/ or in your community, please visit https://cwhhc.ottawaheart.ca/how-get-involved/wear-red-campaign

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