Dr Wynnie Chan explains why it’s not only men who should worry about CHD

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 Health Survey For England 1998, it kills at least 76,000 women in this country each year and it’s the biggest cause of premature death in women under 65.

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

Initially, this causes 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 ‘bad’ low-density lipoprotein cholesterol (LDL) to ‘good’ high-density lipoprotein cholesterol (HDL) 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.

While this information is helpful, can we sit back on our laurels until after the menopause? Sadly not. Some groups of women, including those from low income working families and the Indian subcontinent, diabetics and those who are apple shaped (having more fat around the waist) stand a higher chance of developing heart disease than others.

Secondly, it is clear that smoking, being overweight or obese, having a poor diet, being sedentary and having high blood pressure – all of which are contributing factors – will increase your risk of CHD whether you’re a man or a woman.

How to reduce your risk of CHD

1. Stop smoking. Studies show that compared to smokers, the risk of heart disease is reduced among those who have given up.

2. Watch your diet. Increase the amount of fibre-rich starchy foods, fruit and vegetables you eat by at least half and cut down on foods high in fat and saturated fat. Also reduce the amount of salt in your diet. Government guidelines recommend no more than 6g a day.

3. Take folic acid and selenium seriously. According to international heart disease expert Dr Margaret Ashwell, OBE, the programme manager for the Food Standards Agency’s project on optimal nutrition status, a good intake of micronutrients, particularly selenium and folic acid helps protect against heart disease. The more calories we have the higher our intake of micronutrients. But because women naturally tend to eat less and are more likely to watch their weight during a significant part of their lives, their micronutrients intake will therefore be lower, which could increase their risk of heart disease.

4. Increase physical activity. Try to do at least 30 minutes of moderate exercise five times a week. The Health Development Agency, which carried out a major health review in the UK last year, estimates that if half of those who were already exercising a few times a week increased that to five times there would be a 7% reduction in CHD deaths. Examples of moderate physical activity include brisk walking, swimming, cycling and dancing.

5. Avoid being overweight or obese. The location of fat has an effect on CHD risk no matter what your body mass index is. Apple-shaped women are more at risk than those who are pear-shaped (having more fat around the hips). In 1998, 32% of women in England were classified as being overweight and an additional 21% were obese.

6. Prevent and treat high blood pressure. Studies have found that prolonged reduction of blood pressure levels leads to a reduction of risk for stroke and CHD.

If you are concerned about your risks of developing heart disease, seek advice from your GP.