As long as the heart is ticking and pumping, we stay alive. But if the organ malfunctions, it can kill you either instantly or slowly.
The latest data from the Department of Statistics shows that there is a whopping 54% increase in deaths from coronary heart disease (CAD) in Malaysia over the 10-year period of 2007 to 2017.
From 8,776 deaths in 2007, the figure rose to 13,503 in 2017. Basically, every day, 37 people are dying of CAD, compared to 24 a decade ago.
Although CAD is the leading cause of death in Malaysia and the world, many women are deeply ingrained with the mindset that heart attacks only occur in men.
What is more worrying is that there has been an increase of CAD in women below the age of 55.
According to consultant cardiologist Dr Dewi Ramasamy, current research is now highlighting that apart from traditional risk factors such as hypertension (high blood pressure), high cholesterol, diabetes, inactivity and obesity, risk factors for CAD include gestational diabetes, pre-eclampsia (a condition in pregnancy characterised by high blood pressure), and pre-term delivery.
“Women who have been subjected to these conditions during their childbearing years manifest CAD later in life.
“There seems to be a higher incidence compared to women who did not have any of these conditions while pregnant.
“After delivery, these women are not followed up because they think these conditions are part of pregnancy only.
“Many are told they are okay after delivery as gestational hypertension or gestational diabetes may go away, and there is no further surveillance.
“They may still have hypertension a few months later, but because they don’t do any checks, they are not aware of the progression of these risk factors, which ends up in CAD,” she says.
Other risk factors for women include autoimmune diseases such as rheumatoid arthritis and systemic lupus.
Women also tend to gain weight during pregnancy. Although breastfeeding can help in shedding the pounds after delivery, many women juggle multiple roles and struggle with time management, making it more easy to gain weight, rather than lose it.
This is dangerous as overweight and obesity are major risk factors for CAD.
CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed due to the formation of plaques, made out of accumulated cholesterol and other materials, on their inner walls – a process called atherosclerosis.
As less blood flows through the arteries, the heart muscle can’t get sufficient amounts of the necessary blood or oxygen. This can lead to chest pain (angina) or a heart attack.
Most heart attacks happen when a blood clot suddenly cuts off the heart’s blood supply, causing permanent heart damage.
Over time, CAD can also weaken the heart muscle, leading to heart failure and arrhythmias (abnormal rhythm or rate of heartbeat).
Because CAD often develops over decades, you might not notice a problem until you have a significant blockage or a heart attack.
In the past, not much attention was given to women below 55 when it came to CAD, so this age group was usually not included in clinical trials.
More attention was given to those above 65 because they present the classic symptoms of CAD, and hence are recognised and treated early.
“The below 55 or perimenopausal group may not exhibit typical symptoms in their presentation.
“They may experience shortness of breath, some shoulder/neck pain, feel unwell, tire easily – these are all vague symptoms, and women often attribute them to not exercising or being stressed. So things are missed.
“By the time they come in for treatment, they have more extensive disease, and when treatment is accorded, their outcomes and recovery rates are worse than men,” says Dr Dewi.
The majority of women also believe the symptoms are menopause-related or think CAD is only common among men.
She says, “The obstetrician or gynaecologist should highlight these issues to them, and if necessary, ask them to go for a follow-up with a cardiologist later. Or monitor your condition every six months or thereabouts.
“Most women are also working and don’t make optimal lifestyle changes. They sit long hours at the computer at work and pressure from various sources leads them to develop this condition.
“Evidence says that the older you are, the more prone you will be to certain conditions, especially if you have a family history.
“By 2050, it has been projected that 50% of the population will be diabetic, so things will get worse if nothing is done now.”
Young women with breast cancer have an additional concern.
Dr Dewi explains, “Part of cancer treatment management is radiation. If it is done on the left side, this ionising radiation can also damage the heart and coronary vessels over time.
“This is another issue for young women, as CAD may come 20 years down the road.”
With women above 40, CAD might present itself as gastric or back pain.
“If you’re having stomach pain on and off, don’t assume it is gastric,” warns Dr Dewi.
“See a doctor and don’t procrastinate because time is important. The longer you wait, the more muscles are damaged.
“If the symptoms go off, it’s a warning that something is happening to your arteries. Don’t wait until the next morning, because sometimes, you may never reach the hospital.
“I’ve heard enough about patients like this. When you come in late, everything has progressed, and when treatment is accorded, the benefits are going to be less.
“So the first golden hour is important,” she says.
People don’t listen
Before menopause, women are protected by their hormones, so CAD may only start to show up 10 years after menopause.
However, for a woman below 55 at risk, the condition would have escalated by that time and the prognosis may not be good.
One fallacy is that hormone replacement therapy will help a woman’s heart post-menopause.
“It’s not true as recent trials by the Women’s Heart Initiative reveal that it does not have impact on CAD, although it protects women from strokes and fractures.
“People also ask if they should take aspirin. Well, again, there is no benefit in taking aspirin as a prophylaxis, i.e. if you don’t have anything wrong with your heart.
“However, there is no problem taking it for secondary prevention, that is if you have had a stroke or are having a heart problem.
“On taking omega fish oil as a supplement, previously we said any omega fish oil helps you, but new trials are showing different results.
“To prevent heart disease, you need to take two to four grammes of pure EPA, and not DHA,” says Dr Dewi.
Lamentably, the consultant says cardiac deaths are high because patients just don’t listen.
“I tell my patients once, and they still go back and eat everything they like. They don’t lose weight and when you ask them why, they smile at you and carry on their regular lifestyle.
“Some don’t even adhere to medication, while many men go back to their bad habits such as smoking after a heart bypass, despite the time I spend advising them.
“Yes, people say you only live once, but I think you live all the time, but die once! So, do things in moderation, not indulgence.
“Exercise is still key, especially for menopausal women, because it can reduce up to 80% of all ailments, without the need for medication.
“Work on changing your mindset,” advises Dr Dewi.