The Heart Disease Gender Gap
By Sinéad Berry, Registered Nutritionist (MSc, mBANT, rCNC)
Heart disease is often synonymous with middle-aged, overweight men who smoke and there’s a common misconception that it’s a ‘man’s issue’. But in the UK, heart disease actually kills twice as many women as breast cancer, and is the second leading cause of death among women after dementia and Alzheimer's disease. Research from the British Heart Foundation proposes that this misconception is leading to significant inequalities in care provision and is creating a heart attack gender gap that’s costing women’s lives. The report also claims that a lack of awareness by women (and an assumption that they’re not at risk) means that they’re less likely to recognise the symptoms. When having a heart attack, women also typically arrive at hospital later than men which means additional delays in treatment at a time when every second counts. A study also found that a woman is 50% more likely than a man to receive a wrong initial diagnosis for a heart attack, suggesting a substandard level of care for women. Even after diagnosis, continued sex disparities in a woman’s aftercare results in worse outcomes over the long term, compared to men. Historically, women have also been under-represented in clinical research, including cardiovascular trials, meaning that many diagnostic tests and treatments have been based on data gathered from men.
With over 3.6 million women in the UK currently affected by heart disease, it’s clear that women need to prioritise this aspect of their health. But what can be done to change the narrative around women and heart disease? Raising awareness and changing the perception of heart disease will empower women to take charge of their heart health, better understand the risk and know the symptoms to look out for. More research, specifically in women, is also needed to improve the diagnosis, treatment and aftercare, close the gender gap and save lives.
What are the symptoms that women need to be aware of?
Heart disease and heart attack symptoms can vary from person to person, but it’s vital to recognise common symptoms and get medical help immediately. A heart attack occurs when the heart is deprived of oxygen because flow of blood to the heart is reduced or blocked. There’s some debate as to whether heart attack symptoms differ between men and women, but the general consensus is that the most common symptom for both genders is chest pain or discomfort in your chest that suddenly occurs and doesn't go away. However, in women, other non-chest pain symptoms may include: a sudden onset of weakness, shortness of breath, fatigue, a feeling of systemic illness (without chest pain); mild discomfort in back, chest, arm, neck or jaw (without chest pain). Digestive symptoms such as nausea, vomiting, heartburn and indigestion are also reported and may be mistaken for gut issues rather than heart problems, leading to a delay in diagnosis.
What are the risks for women?
Gender differences are also apparent in the types of heart disease: microvascular heart disease (MVD) tends to affect women more than men — this is when there’s damage to the smaller blood vessels rather than blockages in the large arteries, which is more typical in men. Standard tests may fail to detect this type of heart disease as the blood vessels are so small. Although it’s not yet entirely understood what causes MVD, high blood pressure, changes in oestrogen levels and genetic factors are all thought to be potential risk factors.
Lifestyle choices such as lack of sleep and exercise, poor diet and stress are all known to contribute to heart disease risk. However, unique risks for women include complications during pregnancy such as preeclampsia, gestational diabetes, and high blood pressure, as well as polycystic ovary syndrome and autoimmune diseases, which may all lead to an increased chance of developing heart disease later in life. However the good news is that, as these sex-specific factors can be identified at an earlier age, so modifications to diet, lifestyle and medication (if appropriate) can be made to reduce the likelihood of future complications.
Menopause also marks a significant change in a woman’s cardiovascular health. The decline in oestrogen reduces its protective effects on the heart; this leads to changes in blood vessel function, including the stiffening of artery walls and the potential accumulation of plaque in blood vessels. Research has shown that hormone replacement therapy (HRT) for 2 years is linked with a 30% decrease in risk of heart disease as oestrogen supports the flexibility of the artery lining, although more research is needed. Perimenopausal hormone fluctuations may lead to increased blood pressure, cholesterol levels, and weight gain around the abdomen, all of which are key risk factors for heart disease. Research has also shown that women who experience premature menopause (before age 40) and early menopause (age 40 to 44) are more likely to develop heart disease in the short term.
How can diet help improve your heart health?
A healthy diet is crucial for preventing and managing heart disease. Research shows that eating a Mediterranean-style diet may reduce our risk of heart disease. This way of eating is based on an abundance of nutrient-rich, plant-based foods, including: plenty of fruits, vegetables, nuts, seeds, pulses and wholegrains, a rich and diverse range of fibre and plant-based protein, and healthy unsaturated fats (such as extra virgin olive oil), which may help to reduce harmful cholesterol. The Mediterranean diet also includes a moderate intake of fish, poultry and eggs, whereas dairy and red meat are only eaten occasionally. Processed meats are rarely eaten and neither are other processed foods, refined grains or added sugar. This way of eating is all about balance and flavour, which means it’s easy to stick to. It’s also worth remembering that the Mediterranean diet is about more than what you eat, it’s a lifestyle strategy that places equal importance on physical activity, social mealtimes and resting after eating. These habits promote positive social connections and a less stressful outlook on life.
Tips for a heart-healthy diet
Enjoy a wide range of root, green leafy, salad and sea vegetables.
Aim for six colours of plants a day — red, orange, yellow, green, purple, white.
Use herbs and spices (fresh or dried) freely.
Fruit and vegetables are rich in colour phytonutrients which help protect cells from oxidative stress generated by free radicals and inflammation.
Choose high fibre foods, including wholegrains such as wild or brown rice, rolled oats, wholegrain pasta, breads or brown rice noodles.
Experiment with pseudo-grains such as amaranth, buckwheat, quinoa and millet.
Include legumes into your daily diet with a portion of lentils or pulses, such as butter beans, chickpeas or kidney beans.
Limit refined carbohydrates including white rice, white bread, pasta, noodles, pastries, cakes, biscuits.
Eat a wide variety of plant proteins from lentils, pulses, nuts and seeds.
Eat moderate amounts of animal protein from fish, shellfish, eggs, poultry.
Limit cheese and yoghurt to small amounts.
Avoid processed meats.
Include oily fish (such as salmon, trout, mackerel, sardines), which are high in healthy omega-3 fatty acids, in your weekly diet.
Choose natural cold pressed oils such as extra virgin olive oil, avocado oil, walnut oil, flaxseed oil and hemp oil.
Avoid trans fats, which are found in processed foods and are associated with increased risk of heart disease.
Snack on a small handful of nuts and seeds.
Limit your salt intake to support healthy blood pressure by eating fewer processed and takeaway foods, salty snacks such as crisps and nuts; ready-made sauces and condiments.
Stick to the guidelines for alcohol limits (no more than 14 units per week spread over three or more days) and aim for two alcohol-free days a week.
What lifestyle factors can help improve your heart health?
The food you eat is only one part of the puzzle when it comes to heart health — lifestyle factors such as how much you move, the quality of your sleep, whether you smoke and how much stress you experience can all have a significant impact.
Regular exercise is incredibly beneficial for heart health, positively impacting blood pressure levels, lowering cholesterol and supporting circulation systems. Aerobic exercise (such as walking or swimming) will make your heart work harder and support heart health. It’s recommended that we all do 150 minutes of moderate exercise (where your breathing and heart rate is faster) per week. This can be broken down into sessions of 10 minutes or more and spread out throughout the week, so try to incorporate an exercise regime if you don’t already have one.
Smoking is a major risk factor for heart disease. Women who smoke are at an even greater risk of developing cardiovascular issues than their male counterparts. So if you do smoke, consider quitting.
Chronic stress and anxiety may lead to high blood pressure, as well as high blood sugar, cholesterol, and triglycerides, increasing the risk of heart disease. There’s also an indirect effect that stress may have on heart health: there can be strong emotional associations between certain foods and the feeling of comfort, where reaching for a highly processed sugary treat whenever we feel stressed or upset can easily become a habit. A diet of high-sugar foods has a negative effect on blood sugar balance and may leave you feeling low in energy, mood and less likely to want to stay active. Learning ways to help you manage stress and anxiety will not only benefit your mental health and overall wellbeing, but may also help keep your heart healthy too.
ABOUT THE AUTHOR:
Sinéad Berry
Registered Nutritionist (MSc, mBANT, rCNHC)
Sinéad Berry is a registered nutritionist (MSc, mBANT, rCNHC) and health writer, with a Masters degree in Personalised Nutrition. Sinéad supports women struggling with perimenopause symptoms to feel empowered to achieve their health goals through a simple and joyful approach to food. Her research examining the role of vitamin D in female infertility as a symptom of polycystic ovary syndrome (PCOS) was published in the Journal of Reproductive Immunology. She has also trained in professional cooking skills at the prestigious Leiths School of Food & Wine. Sinéad works with clients on a one-to-one basis and is a food & health editor providing copywriting, recipe editing and technical services to professionals and brands in the nutrition industry.
Instagram: @sineadberrynutrition
Website: www.sineadberry.com