CORONARY artery disease, not cancer, is the leading cause of death and disability in women, a leading cardiologist has warned.
Moreover it is under-recognised, under-diagnosed and under-treated by women patients and doctors, according to Dr Lakis Anastassiades.
Dr Anastassiades, who was trained in the USA and works at the Cardiovascular Diagnostic Centre in Nicosia, blamed misconceptions for women’s ignorance on the subject, despite the fact that prevention played a vital role in saving lives.
“Everything is about prevention,” he told the Sunday Mail. “Once diagnosed with coronary artery disease or once patients have had a heart attack, it’s already too late.”
Unfortunately, most people are under the illusion that coronary artery disease is mainly a man’s ailment, he said. In fact, numerous studies show that very few women perceive heart disease as the “greatest threat” to their health.
“The majority of them falsely believe that they are more likely to develop cancer than heart disease,” he said.
“Although we have no detailed statistics in Cyprus, judging from clinical practice and what we hear at scientific meetings, we believe the statistics are the same here as in the rest of the western world…
“Coronary artery disease is the leading cause of death in women. But because there has been so much talk about cancer in the past 10 years, all women are scared of cancer rather than coronary artery disease. This is a misconception.”
However, research has shown that women may not be diagnosed or treated as aggressively as men, and their symptoms may be different.
Anastassiades confirmed a recent report from the United Kingdom, which pointed out continued gender bias in diagnosing coronary artery disease in women.
Women seemed less likely to be diagnosed with having a heart attack, despite complete information available to doctors, he said. For instance, women presenting to emergency rooms with chest pain were less likely than men to have an electrocardiogram, or to be treated with aspirin, and were more likely to be given tranquillisers, he said.
“This is because women display chest symptoms such as pricking pains, shortness of breath, tachycardia and chest pain more frequently than men. Because doctors know these symptoms may be brought on by hysteria, nervousness, anxiety and tension, they may miss an underlying heart condition.”
He said doctors needed to be more careful when interpreting women’s symptoms. He also said an electrocardiogram may be misleading and harder to diagnose.
But women were also less likely to seek a cardiologist’s advice. In fact women were more likely to think of a having a mammography than a stress test, which is wrong, he said.
“There is no definite age for women to start having regular check-ups. They could start at 30, 35 or 40 and then their doctor will guide them accordingly. They may do a stress test in their 30s but won’t have to do one every year. The doctor will guide them when it’s necessary to come back for another one. In the meantime, their weight, blood cholesterol level, diet and exercise levels will be monitored.”
Dr Anstassiades said it was good to have a follow-up every couple of years, and that women over 50 should definitely see a cardiologist. “After menopause, an annual check-up is essential,” he said. “Even having a check-up as young as 30 is a good idea, as it gives the cardiologist a reference for future comparison and allows the doctor to find if his patient has hypertension or high cholesterol levels and doesn’t know it, or if she smokes and has any hereditary predispositions.”
Major risk factors for coronary artery disease are the same for men and women, he said. These include smoking, high blood pressure, high blood cholesterol levels, diabetes, obesity and a sedentary lifestyle. Coronary artery disease is unusual in premenopausal women, particularly in the absence of other risk factors. But developing the condition after menopause is a well-documented occurrence, he said, adding the role of female hormones remained a confusing issue.
Dr Anastassiades said the usual symptoms of heart attack were chest discomfort, a pressure-like feeling in the chest, squeezing or tightness-like pain in the centre of the chest that lasts longer than a few minutes. The pain may spread to the shoulders, the neck, the jaw, the arms and may be accompanied by cold sweat, nausea and vomiting.
“Women displaying these symptoms should seek advice, preferably from a cardiologist, so that the doctor can assess whether these symptoms are related to the heart in any way,” he said.
Dr Anastassiades said there was also a misperception that coronary artery disease is a less painful, quicker way of dying than cancer. “However, in reality, heart disease can cause years of disability, pain and a decreased quality of life. People tend to survive a heart attack and then become heart cripples. They go into congestive heart failure because part of the heart muscle dies as a result of the heart attack and then they live with what remains of a much weakened heart muscle. This leads to shortness of breath, reduced effort tolerance, gasping for air brought on by minimal exertion, sitting upright in bed and the legs get swollen with oedema.”
ACCORDING to the US Department of Health and Human Services:
Coronary artery disease occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to build-up of a material called plaque on their inner walls. The build-up of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. Reduced or cut-off blood flow and oxygen supply to the heart muscle can result in:
Angina – chest pain or discomfort that occurs when the heart does not get enough blood.
Heart attack – happens when a blood clot develops at the site of plaque in a coronary artery and suddenly cuts off most or all blood supply to that part of the heart muscle. Cells in the heart muscle begin to die if they do not receive enough oxygen-rich blood. This can cause permanent damage to the heart muscle.
Over time, CAD can weaken the heart muscle and contribute to:
Heart failure – on heart failure, the heart can’t pump blood effectively to the rest of the body. Heart failure does not mean that the heart has stopped or is about to stop. Instead, it means that the heart is failing to pump blood the way that it should.
Arrhythmias – changes in the normal beating rhythm of the heart. Some can be quite serious.
