Two years ago, Sharon was feeling fantastic, having finally smashed out a great gym session after weeks of fatigue. And no wonder! The fit, health-conscious 52-year-old had been training in a new role as executive assistant to a chief government officer and was obviously overloaded and tired. That was in the past, thought Sharon as she put petrol into her car. She would reward herself with a coffee from her favorite barista at the servo even though she was experiencing a random bout of heartburn.
After ordering her coffee, Sharon’s heartburn intensified and she started retching and sweating and feeling strangely dissociated from her body. Although Sharon couldn’t feel her arms, she managed to wave her hand at the mention of an ambulance. “I remember thinking this is a complete over-reaction to heartburn,” thought Sharon in the ambulance.
“They’re going to think I am wasting their time.” Heart trouble did not cross Sharon’s mind until the cardiac surgeon told her she was having a major heart attack.
Sharon was one of the fifty women who experience a heart attack each day in Australia.
Heart disease, also known as cardiovascular disease (CVD), claims more Australian women’s lives than any other condition. Surprised? You may be thinking breast cancer kills more women because, surely, heart attacks are a man’s disease? In reality women are two-and-a-half times as likely to die from
heart disease than breast cancer. In fact, in 2019, breast cancer claimed eight women’s lives each day. Heart disease killed 20 women each day!
If you are thinking women’s heart disease has been flying under the radar, you’re not alone. Risks for heart disease rise sharply after menopause, but things get complicated because CVD symptoms manifest less specifically in women than men. Worse, women tend to ignore symptoms and wait too long to get help. Let’s unpack these factors.
Why does the risk of heart disease rise after menopause? Dr. Sonia Davison is an endocrinologist with Jean Hailes for Women’s Health and President of the Australasian Menopause Society. She explained that not only does oestrogen keep blood vessels more elastic and flexible, but as we age, our arteries naturally become less elastic.
“There is some protective effect of oestrogen and with menopause, there is a great lowering of oestrogen, both normal and natural, and the protective effect is lost. And the arteries are getting stiffer with age.”
The upshot of less compliant blood vessels is threefold. Our hearts must pump harder to move blood around our bodies, the muscle in the heart thickens and becomes less elastic and we have a slight rise in blood pressure.
But wait, there’s more. Our bodies change shape with menopause as we tend to deposit weight around our waists rather than our hips. Abdominal fat is also associated with an increased risk of CVD and, unfortunately, more severe symptoms of menopause such as hot flushes and night sweats.
Dr Davison points out that carrying added weight during menopause is like wearing a coat in hot weather.
“The coat makes you feel warm and if you have more fat, you are more insulated and therefore, if your core temperature increases with flushes and
sweats, you are more likely to feel it.”
Dr Davison says hypertension, diabetes and obesity also increase with age and these are added risk factors for heart disease. Therefore, losing weight and staying fit not only reduces the heart disease risks but also the symptoms of menopause.
Menopause and age-related heart disease risks such as less elastic blood vessels are unavoidable. Why then do so many women die from heart disease?
The problem for women is that many heart attacks occur without warning or with vague symptoms they readily attribute to fatigue like Sharon. This is how 40% of heart attacks in women are fatal. Unlike the traditional male symptoms of chest pain, shortness of breath and nausea, women might experience pain in their back, neck, or jaw, heartburn-like sensation, light-headedness, dizziness, fatigue and sweating. These symptoms could relate to common conditions like a virus, over-exertion, or even a hangover!
Retired school principal, Jenny experienced jaw pain that came and went for months. The active 68-year-old made a note to mention it to her doctor at her
half-yearly health check. Soon after, while waiting to see her accountant, the jaw pain hit hard accompanied by sweating. She considered asking for an ambulance but soldiered on, after all, she had a job to do. Job done, she
returned home to rest. “After a couple of hours, it was the same thing, my jaw couldn’t release itself and I had pain between my shoulder blades,” says Jenny.
Fortunately, her husband called the doctor’s surgery and after explaining Jenny’s symptoms, called an ambulance. Emergency surgery saved Jenny’s life. Jenny’s desire to finish the job of seeing the accountant made her a textbook candidate for a late-stage heart attack presentation. Research shows women are more likely to finish chores at hand when experiencing vague heart attack symptoms than seek medical assistance.
Interestingly, Sharon also experienced ongoing jaw pain in the weeks leading up to her heart attack. She didn’t see a dentist because she couldn’t identify the troublesome tooth, so vague was the pain. It’s no wonder these vague and, in the early stages, not inconvenient symptoms don’t have women rushing off to hospital. A 2012 study reported that 42% of women having heart attacks had no chest pain. Worse, the lack of chest pain was associated with increased death due to women presenting with different symptoms.
Why do women’s symptoms present differently to men?
Dr Karen Magraith, GP and President-Elect of the Australasian Menopause Society, says it can be difficult for doctors and women themselves to recognise what are regarded as atypical symptoms.
“This is partly because women have different hearts to men, and partly because we have used men as the ‘benchmark’ for what we think of as the usual symptoms of heart disease. Women have traditionally been under- represented in CVD research, but this is starting to change now. Further research and education are needed in this area.”
Our hearts and heart attack symptoms may be different to those of men, but our risk factors of heart disease are not. Shared risk factors we can control are smoking, being overweight, having high blood pressure and high cholesterol
and being physically inactive.
Doctor Magraith says, “Some women will require medication to reduce their cardiovascular risk but for many women the most important thing is their lifestyle.”
Do you think your lifestyle is healthy enough to reduce your risk factors? Here are some surprising risks of CVD. Research shows that complications during pregnancy like pre-eclampsia and gestational diabetes may increase the risk of heart disease later in life.
There are two simple ways to reduce your risk of heart disease before and after menopause. Firstly, maintain a healthy lifestyle and two, have regular health checks. The Heart Foundation recommends all women aged 45+ years
(30+ for Indigenous Australian women) see their GP for a Medicare-funded Heart Health Check to learn your CVD and stroke risk. Also, check out the Jean Hailes for Women’s Health website.
In fact, today is the perfect time to think about your heart health because February is Red Feb, heart disease awareness month. Also, think of your loved ones by looking after yourself. “Just remember to look after yourself,” says Sharon, “and remember heart disease is the biggest killer of women in this country… because we ignore our symptoms.”
Jenny’s message is similar. She has learnt not to be stoic with pain because you are no use to the people you love.
“If I get a niggle, I won’t put it off,” she says. “If your heart is not healthy, you can’t love. Your heart is the centre of your being.”
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