Women and heart disease

Traditionally, coronary heart disease (CHD) has been viewed as a male disease. For years health professionals have focused their attention on men as primary targets for prevention.

But, after cancer, CHD is the second major cause of death among women in the UK. According to the British Heart Foundation, 54,491 women died of CHD in 2001. As a result of greater awareness of CHD risk, the number of deaths in women dropped to 47,287 in 2004. The number of deaths from breast cancer in that year was 12,338. CHD still accounts for 27 per cent of deaths in women under 75.

Problems begin when the blood vessels to the heart become narrowed (due to the accumulation of cholesterol and small blood clots deposited on the blood vessel walls) reducing blood flow to the heart.

Initially, this may cause chest pain – called angina – after physical exertion. Eventually one of the blood vessels may become totally blocked and stop blood supply to part of the heart. This leads to muscle damage due to lack of oxygen, which can lead to a heart attack. If the damage is extensive, the heart may beat irregularly or stop altogether, which can be fatal.

On average, women tend to develop CHD ten years later than men. It’s thought that pre-menopausal women are less at risk because:

• They tolerate high blood cholesterol levels better than men. The ratio of `good? high-density lipoprotein cholesterol (HDL) to 'bad' low-density lipoprotein cholesterol (LDL) is higher in pre-menopausal women because oestrogens (female sex hormones) raise levels of 'protective' cholesterol and reduce the 'bad' levels.

• They tend to have a more healthy diet. Dietary surveys show that women eat more fruit and veg than men and therefore have a higher intake of antioxidants. Antioxidants, such as vitamins A, C and E, are also found in vegetable oils, nuts and seeds and can help destroy peroxides, the chemicals formed when free radicals (by-products produced by the breakdown of foods or environmental pollutants) combine with LDL cholesterol. Peroxides play a part in the development of ‘plaques’ or deposits that build up on the artery walls and may increase risk of heart disease.

• They have low iron stores. Pre-menopausal women tend to have low iron stores because of menstrual losses, which is beneficial because excess iron may lead to further damage by free radicals.