WOMEN AND HEART DISEASE

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Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in North America. Five times as many women die from heart disease as they do from breast cancer[1]. However, women are often unaware of their risks and how CVD can differ from men in both symptom presentation and location of disease in the heart vessels. In addition, women are under-represented in the research that is used for the development of diagnostic and clinical management guidelines[2]. These factors have led to delays in obtaining accurate diagnosis and appropriate care for women presenting with symptoms of heart disease.

Understanding these differences is key to empowering women to understand their risks and when to seek medical attention.

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SIGNS AND SYMPTOMS OF A HEART ATTACK IN WOMEN 

Many of us are aware of the signs and symptoms of a heart attack (also known as a myocardial infarction or MI). These include chest pain (described as squeezing pressure or heaviness) that can radiate to the jaw, arms, abdomen or back. Symptoms can also include shortness of breath and/or heart palpitations.

Though women often do present with chest pain, many women describe this experience differently than these classic symptoms, such as dullness, discomfort or burning rather than overt pain. Women can also present with symptoms that may seem vague and don’t necessarily point to a cardiovascular origin.

Women’s symptoms of an MI can include:

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  • Extreme fatigue

  • Shortness of breath with, or with without, chest pain

  • Light-headedness

  • Cold-sweats

  • Nausea and vomiting

  • Indigestion and/or heartburn

Recognizing these symptoms is important so women can seek appropriate medical treatment and receive timely care.

WHY THESE DIFFERENCES OCCUR

Women are more likely to have disease in the smaller vessels of the heart, as opposed to the larger coronary arteries more often seen in men. This different location leads to the different symptoms outline above. It also poses challenges for physicians in terms of where to look for disease and decide on the correct imaging or other diagnostic tests.

Another physiological difference between men and women is the hormonal changes throughout life. Though not necessarily a reason for the differences in symptom presentation, hormonal changes dictate when the risk of CVD increase in women. Estradiol (one of the 3 forms of estrogen) has cardiovascular-protective effects by a number of mechanisms including protecting the vessels against oxidative damage. The decline in estrogen during menopause increases the risk of cardiovascular disease. Women are encouraged to speak with their health care provider about the safety and options for hormone replacement therapy, including herbal medicine or bio-identical hormones.

THE ROLE OF NATUROPATHIC MEDICINE IN CARDIOVASCULAR HEALTHCARE

PREVENTION OF RISK FACTORS

Naturopathic doctors are a valuable addition to a healthcare team when it comes to the prevention and management of cardiovascular health. Our goal is to help women understand and manage their risk factors for CVD which include:

  • Hypertension (high blood pressure)

  • High blood sugar or diabetes

  • Physical inactivity

  • High cholesterol levels

  • Smoking

  • Healthy weight management

  • Mental health including depression and anxiety


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The following lifestyle factors help build a resilient foundation for the prevention and management of CVD:

  • Dietary guidance

  • Nutritional supplements when higher dosing of specific nutrients is indicated

  • Exercise prescription

  • Quality sleep support

  • Stress management

  • Smoking and other substance cessation

At Fairfield Health and Wellness clinic, the naturopathic doctors are also trained in herbal medicine, IV and ozone therapy that can further support the cardiovascular system as a whole.

An individualized approach with the patient’s medical care team can help target and support these areas. This approach can also ensure women are aware of the signs and symptoms of heart disease and feel empowered to seek proper medical care.


About the author

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Dr. Whitney Baxter is a licensed naturopathic physician practicing in Victoria, BC. She graduated from Boucher Institute of Naturopathic Medicine, holds a BSc in Kinesiology and is a Certified Exercise Physiologist (ACSM). She is an avid runner and loves everything to do with mountain life on Vancouver Island, BC.




References

[1] (2020), Heart and Stroke Foundation of Canada.

[2] Chrysohoou, C., et al. (2020). Cardiovascular Disease in Women: Executive Summary of the Expert Panel Statement of Women in Cardiology of the Hellenic Cardiological Society. Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese, S1109-9666(20)30215-3. Advance online publication.

3. Brewer, L. C., Svatikova, A., & Mulvagh, S. L. (2015). The Challenges of Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women. Cardiovascular drugs and therapy, 29(4), 355–368.

4. Saw, J., et al.(2019). Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. European heart journal, 40(15), 1188–1197.

5. Taqueti V. R. (2018). Sex Differences in the Coronary System. Advances in experimental medicine and biology, 1065, 257–278. https://doi.org/10.1007/978-3-319-77932-4_17

6. Mehta, P. K., Bess, C., Elias-Smale, S., Vaccarino, V., Quyyumi, A., Pepine, C. J., & Bairey Merz, C. N. (2019). Gender in Cardiovascular Medicine: Chest Pain and Coronary Artery Disease. European Heart Journal. 0, 1–8. doi:10.1093

7. McMaster University. (2019). Simple cardiac risk score can predict problems with blood flow in the brain. ScienceDaily; Anand, S. et al. (2019). Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease. European Heart Journal.

8. (2015). Angina in Women Can Be Different Than Men. American Heart Association.

9 (2020). A Fighting Chance, 2020 Spotlight on Women. Heart and Stroke Foundation of Canada.

10. Iorga, A., Cunningham, C.M., Moazeni, S. et al. (2017). The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biol Sex Differ 8, 33. https://doi.org/10.1186/s13293-017-0152-8