Women and the myth of healthy hearts

It is a myth that women are less prone to cardiovascular diseases (CVDs) when compared with men. Doctors say women who have gone through menopause could face the same risk of developing CVDs due to the decrease of oestrogen, a hormone that can protect the heart.

CVDs refer to disorders of the heart and the blood vessels, including coronary heart disease, deep vein thrombosis and cerebrovascular disease, among many others.

CVD is the leading cause of morbidity and mortality in both men and women, says Dr Praveen P Sadarmin, consultant interventional cardiologist, Narayana Hrudayalaya, Bengaluru. He says that according to a study, women get CVD about seven to 10 years later than the average man and it is still the leading cause of death.

“This lag phase is mainly due to the cardioprotective effect of oestrogen,” says Dr Sadarmin. “The misconception that women are less prone to CVD has led to fewer women being referred for appropriate testing, which in turn leads to under recognition and under treatment. Some of the recent studies have shown the incidence of heart attacks going down in middle-aged men (35-54 years) but going up among women of similar age.”

Plummeting oestrogen levels and CVD risks

Oestrogen plays a vital role in preventing atherosclerosis, which could lead to heart attacks. Atherosclerosis is a condition where the arteries become narrowed and hardened due to the build-up of plaque (fats) in its walls. “As oestrogen wanes in the body with menopause, atherosclerotic plaque inside the coronary arteries changes into more vulnerable lesions, which can potentially rupture, causing a heart attack,” says Dr Sadarmin.

According to Dr Pradeep Kumar D, senior consultant, interventional cardiology, Aster CMI Hospital, Bengaluru, oestrogen improves the vascular health by increasing the concentration of nitric oxide in the blood. Nitric oxide is a vasodilator, which means that it helps the blood vessels to relax and expand, thus enabling the blood to flow effectively through the body.

“Oestrogen reduces the chances of clotting in the blood vessels and thereby reduces the risk of acute heart attacks and stroke,” says Dr Kumar. “It also improves cardiac contractility (ability of the heart muscles to contract), reduces inflammation, reduces tissue hypertrophy (an increase in tissue mass) and reduces infarct size (a small area of dead tissue due to failure of blood supply). All these reduce the chances of developing blocks in the blood vessels, the formation of clots and heart attacks. And in the event of a heart attack, oestrogen reduces the damage to the heart tissues.”

Dr Kumar believes that though there could be many reasons for low levels of oestrogen — like primary ovarian insufficiency, eating disorders, genetic disorders, autoimmune diseases affecting the ovaries, surgical removal of the ovary, chemotherapy and diseases affecting the pituitary gland and hypothalamus — the most common cause for low oestrogen is menopause. And women who have early menopause are particularly at the risk of developing CVD.

Dr Sadarmin mentions that women with hormonal imbalance, particularly oestrogen deficiency, tend to have early menopause and lose the protective cover. “Some studies have suggested that women with early menopause (under the age of 40) have a two-year lower life expectancy compared to women with normal or late menopause,” Dr Sadarmin says. “According to another study, oestrogen deficiency can cause a seven-fold increase in the risk of heart attacks. There are numerous assumptions regarding why menopause happens early, but much of this is under debate and research continues.”

Dr Preeti Prabhakar Shetty, senior consultant, obstetrics and gynaecology, Apollo Hospitals, Bengaluru, points out that women who have premature menopause are not only at a higher risk of developing cardiovascular diseases but also neurological diseases, psychological disorders and osteoporosis. “This is primarily because during menopause, oestrogen which protects the heart, the blood vessels, bone, brain, skin and vagina comes down,” she says. “The decreasing levels could cause problems to all these organ systems.”

Aiming for a healthy heart

Dr Sadarmin says that maintaining a healthy lifestyle can lead to an improvement in the overall heart health of women. “Prompt recognition and treatment of diabetes, hypertension, dyslipidaemia (high cholesterol), smoking cessation and stress control go a long way in avoiding complications from CVD,” he says. “A holistic approach from the society at large to changes happening at the individual household level is required to uplift women’s health.”

Dr Shetty says there is no lifestyle change or activity which can prevent premature menopause. “But a lifestyle change can help one transition into menopause more smoothly,” she says. “A healthy diet that has less fat and more fibre, taking calcium and vitamin D supplements and exercise can keep one mentally and physically fit.”