Gender

Men

Men generally face a much higher risk of heart disease than women. They also tend to suffer heart attacks earlier in life. After women reach menopause however, they are just as likely to have heart attacks as their male counterparts of equal age; they are also more likely to die from such cardiac complications than the latter. 

Women At Risk

Heart disease is often regarded as a “male” disease. Statistics, however, belie this perception.

Cardiovascular disease is the largest single cause of female mortality and accounts for one-third of all deaths among women worldwide, killing more than eight million women annually. A similar trend can be seen in Singapore, where cardiovascular disease is likewise the leading cause of death for women. Three categories of women – namely, menopausal women, women taking oral contraceptives, and pregnant women – are particularly vulnerable in this respect.
Women who have reached menopause have a markedly higher risk of coronary heart disease and heart attack than their pre-menopausal counterparts. This is because of the drop in the female sex hormone oestrogen following menopause. Oestrogen is thought to have a protective effect on women’s hearts by causing women to have, relative to men, a lower systolic blood pressure, a lower level of LDL (bad) cholesterol, and a higher level of HDL (good) cholesterol. Consequently, less cholesterol deposits build up in the arteries of women, thereby reducing their risk of developing cardiovascular disease.
As a woman nears the age of menopause however, her ovaries produce less and less oestrogen. This leads to a corresponding increase in her “bad” cholesterol level and blood pressure, coupled with a decrease in her “good” cholesterol level. In the years following menopause, a woman’s blood lipid levels and risk of heart disease rise significantly and become similar to those of a man.
Until recently, it was thought that hormone replacement therapy (HRT) consisting of either oestrogen alone or oestrogen combined with progestin would protect post-menopausal women against heart disease in the same way as natural oestrogen does before the onset of menopause.
Studies conducted by the United States’ Women’s Health Initiative in 2002 and 2003 have, however, cast doubt on this belief. These studies suggest that HRT in the form of oestrogen alone has no impact either way on heart disease in menopausal women. More alarmingly, the research indicates that taking oestrogen alone appears to increase the risk of stroke and uterine cancer, while combination HRT consisting of oestrogen plus progestin may lead to an increased risk of breast cancer. In light of these findings, post-menopausal women who already have heart disease should avoid HRT altogether and should instead try to protect their hearts by addressing modifiable risk factors such as hypertension, high levels of “bad” cholesterol, smoking, and lack of exercise.
Another group of women who face a slightly higher than average risk of cardiovascular disease is those who take oral contraceptives. These women may find their blood lipid levels detrimentally affected by the hormones contained in these pills. They are also more likely to have blood clots forming in vital blood vessels. If a woman taking oral contraceptives is also a smoker, her risk of developing cardiac complications would all the more rise, especially once she reaches the age of 35.
As for pregnant women, they face a greater likelihood of developing palpitations, hypertension, and congestive heart failure because the metabolic work of the heart increases by about 30-50% in the course of pregnancy. Pregnancy-related palpitations are rarely dangerous. Hypertension and congestive heart failure, in contrast, are potentially more serious and require close monitoring. As such, women with existing heart problems should consult their cardiologists before they become pregnant so that their conditions can be evaluated and stabilised before the changes of pregnancy occur.
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