Many women do not think they are at risk of a heart attack. But cardiovascular disease, associated with a build-up of fatty deposits in the arteries and an increased risk of blood clots, was the leading cause of death for women here last year, according to a check of the Registry of Births and Deaths.
Only 9 per cent of the 1,002 women aged 21 to 64 surveyed by the Singapore Heart Foundation (SHF) between January and March this year knew this fact.
Common cardiovascular diseases include coronary heart disease, which causes heart attack and heart failure; and carotid artery disease, where blood supply to the brain is disrupted, resulting in stroke, brain damage and death.
The SHF survey, titled Go Red For Women, also found that 34 per cent of respondents believe that breast cancer is their biggest health threat. But actually, cardiovascular disease claimed the lives of 2,689 women here last year, while breast cancer caused 445 deaths.
Dr Goh Ping Ping, a cardiologist at Mount Elizabeth Hospital, noted that women, especially those who are younger, tend to overlook the danger of heart disease.
Cancer diagnoses are “more commonly heard of and appear more sinister”, she said.
“But the fact is, heart disease kills six times as many women every year and can lead to debilitating conditions such as heart failure.”
Dr Rohit Khurana, a senior consultant cardiologist with Harley Street Heart and Vascular Centre at Gleneagles Hospital, said there is “an unfortunate lack of awareness” of cardiovascular disease in women not only among female patients, but also among healthcare professionals.
This may be due to an underrepresentation of women in heart disease research, he said, with women making up only 30 per cent of participants in most studies and trials.
“Gender differences in the symptom presentation result in women having longer delays in recognition, investigation and, ultimately, treatment for their heart condition.
“This combination of inadequate research and lack of examination widens the gap in knowledge about cardiovascular disease in women, increasing the risk of delayed treatment and a poorer overall prognosis among female patients.”
The main risk factors for cardiovascular disease include high blood pressure, high blood cholesterol, diabetes, smoking, physical inactivity, obesity or being overweight and a family history of the disease.
Apart from chest pain, which can hit both men and women, the symptoms of a heart attack more common in women are neck, jaw or shoulder pain, shortness of breath, nausea, feelings of indigestion and fatigue.
These symptoms may not be as noticeable as the crushing chest pain associated with heart attacks. This might be because women are more likely to have blockages in the tiny vessels within the heart rather than the large arteries – a condition called small vessel heart disease.
Dr Khurana said women also tend to have “silent” heart attacks which have no symptoms at all.
“This may be due to women having underlying conditions such as diabetes which may bring about numbness or a reduced ability to feel pain,” he added.
According to Dr Goh, the risk of heart disease in women increases after menopause due to a drop in the female hormone oestrogen.
“Oestrogen is believed to have a good effect on the inner layer of artery wall, helping to keep blood vessels flexible to accommodate blood flow. Oestrogen also has a protective effect against hypertension and high cholesterol,” she said.
After menopause, women experience lower levels of good cholesterol and higher levels of bad cholesterol, which increase their risk of cardiovascular disease and atherosclerosis – the build-up of fats, cholesterol and other substances in and on the artery walls, which can restrict blood flow.
Dr Goh said prevention against cardiovascular disease should start as early as possible, even though the risk of such diseases in women increases after menopause.
“Women should not wait till they are in their 40s before making heart health their priority. Early risk assessment and early detection of risk factors are important, as well as early adoption of a healthy diet and exercise,” she said.
She advised those aged 18 years old and above to go for screening of cardiovascular disease risk factors such as diabetes and hypertension.
Depending on the results, a regular cardiovascular screening or further evaluation for heart disease may be suggested by the doctor.
Said Dr Khurana: “Women need to be educated about their risk of cardiovascular disease and taught to recognise the symptoms of coronary heart disease and stroke early so that they can speak to a doctor immediately when they experience them. Early detection and treatment improves long-term outcomes and quality of life.”
Here are seven tips to manage or prevent cardiovascular disease.