Why heart attacks can be more dangerous for women

SINGAPORE - Women, do you know what your greatest killer is?

If you guessed breast cancer, you are wrong. It's heart disease.

In 2010, ischaemic heart diseases accounted for 3,293 deaths in Singapore. Also known as coronary artery disease, the condition affects the blood supply to the heart, and can result in a heart attack.

It is one of the most common causes of death, second only to cancer. Heart attacks, hypertension and stroke accounted for 25.4 per cent and 21.5 per cent of deaths among men and women respectively.

Yet while more than 200,000 women around the world die each year from heart attacks - five times as many as those who die from breast cancer - women here remain blissfully ignorant of this very real risk.

The Singapore Heart Foundation (SHF) revealed during its annual Go Red For Women (GRFW) Public Symposium held earlier this month that according to its latest survey, a third of women here felt they were at low risk.

They also felt that they were helpless to prevent a heart attack, the survey revealed.

Nearly half said they do not associate chest pains with heart attacks, and only 12 per cent had spoken to their doctors about their heart health in the past year.

These distressing findings is in part linked to the unfortunate fact that few are aware that heart attacks in men and women differ greatly, both in nature and in symptoms leading up to the attack.

For reasons unclear, men are more likely to suffer from heart attack than women. However, the risk of heart attacks for women increases after menopause, revealed Gleneagles Medical Centre cardiologist Associate Professor Mak Koon Hou.

He explained that for those aged 20 to 34 years, heart attacks have been found to be 10 times higher in men than in women. But the difference narrows to about two times higher in men than in women for those between 60 and 64 years of age.

More alarmingly, women who suffer from heart attacks have a higher risk of dying than men. Fifty per cent of female patients died within 28 days of diagnosis, compared to 38 per cent in men, a previous study revealed.

Symptoms differ in heart attacks for women

According to Dr Mak, men are more likely to experience the classical symptoms of a heart attack, such as crushing central chest pain, which is associated with the shortness of breath or cold sweat.

For women, it may just be vague discomfort or mere tiredness.

This could possibly be linked to the drastically different outcomes between the sexes.

"Lack of knowledge and understanding of heart attack among women may lead to hesitation in seeking medical attention," Dr Mak said. And any delay in treatment can cost a person his or her life.

Women may perceive the condition differently and may be less likely to accept treatment recommendations, particularly invasive therapeutic procedures.

Younger women who suffer from heart attacks are more likely to succumb than younger men.

The reason for this observation is unclear, but may be related to the fact that since heart attacks occur infrequently among pre-menopausal women, patients may ignore the symptoms and doctors are less likely to make the diagnosis.

Nature of heart attacks differ too

There are several variations between the two sexes regarding heart attacks, which extends beyond symptoms, Dr Mak explained.

The precise mechanism to trigger a heart attack is unclear.

There are several factors - such as high blood pressure, diabetes mellitus, abnormal lipid profile and smoking - that have been known to increase the risks of heart attacks.

Both men and women share these risk factors, but the processes leading to heart attacks differ, Dr Mak said.

Although the heart is larger and heavier for men, there is little difference in the way in which the heart functions mechanically. But the response of the heart to different events and stresses may not be the same for the two sexes, he said.

Among men, plaque rupture is believed to be the principal underlying mechanism.

This means that the wall of the blood vessel breaks suddenly, and the content of the vessel wall is released into the channel.

The interaction between these substances and blood leads to clot formation, which blocks blood flow.

Among women, the erosion of the vessel wall is believed to be an important factor that causes blockage.

Women: Heart attacks may be more dangerous for you

Heart attacks are undeniably dangerous for both men and women.

However, women face the disadvantage of their symptoms not being clear-cut. Hence, the diagnosis may be delayed.

Prolonging time to treatment may result in more damage to the heart. Understandably, the greater amount of damage, the worse the outcome.

Furthermore, most clinical studies on treatment are conducted mainly on men.

So whether the efficacy and safety of these treatment procedures for women - in particular, the dosage used - is less certain.

Prevention is the best cure

If you are wondering what you can do to cut your risks of getting a heart attack, the answer is clear: A healthy lifestyle.

The measures taken for healthy lifestyle is applicable for everyone, such as adopting healthy eating habits and lifestyle practices.

Exercise regularly, Dr Mak advised. Eat more vegetables and less processed and fried foods, he added.

However, if you want to be more certain, there are blood tests and cardiac investigations that may be useful in stratifying heart attack risks.

This is best discussed with your doctor regarding the most suitable approach for you, Dr Mak said.

According to SHF, data collected by the Singapore Cardiac Data Bank has shown that women admitted into medical institutions with acute coronary syndrome (ACS) are on average 10 years older than the men.

Compared to the men, women also have a higher probability of harbouring a number of co-existing conditions. These included depression, increased heart rate and chest pains not commonly associated with the heart.

They also had a higher incidence of risks for heart disease, including high blood pressure, diabetes and kidney failure.

Commenting on the findings, Associate Professor Carolyn Lam of the National University Heart Centre, Singapore said: "Women need to recognise that they are at risk of heart attacks too and they must be alert to early warning symptoms."

She cautioned women to seek medical attention before their medical condition gets worse and complications occur.

"Early detection and treatment will hopefully lead to better outcomes in women," she added.

yamadak@sph.com.sg