NRIS! Do you know?

Recently, many of you may have noticed many doctors (including myself), wearing a “Red Dress Pin” on their lapels or on some visible part of their outfits. It was considered an unusual fashion statement, and attracted a lot of attention and questions. What this unusual accessory symbolized was the lack of awareness of the growing number of women developing heart disease and stroke. Traditionally, heart disease has been viewed as a man’s disease. Recently, there has been a growing awareness of the incredible high risk that women face of having a heart attack. This past February was the “American Heart Month”.

Heart disease isn't just a man's disease. Heart attack, stroke and other cardiovascular diseases are devastating to women, too. In fact, coronary heart disease, which causes heart attack, is the leading cause of death for women in America. Many women believe that cancer is more of a threat, but they're wrong. Nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer, including breast cancer. 

The American Heart Association has identified several factors that increase the risk of heart disease and stroke. The more risk factors a woman has, the greater her risk of a heart attack or stroke. Some of these risk factors you can't control, such as increasing age, family health history, and race and gender. But you can modify, treat or control most risk factors to lower your risk.

Uncontrollable risk factors:

Increasing age — As women grow older, their risk of heart disease and stroke begins to rise and keeps rising with age. 
Sex (Gender) — Men have a greater risk of heart attack than women, and they have attacks earlier in life. Each year about 40,000 more women than men have strokes, and more than 60 percent of total stroke deaths occur in women. 
Heredity (family history) — Both women and men are more likely to develop heart disease or stroke if their close blood relatives have had them. Race is also a factor. Black women have a greater risk of heart disease and stroke than white women. Compared with whites, African-American men and women are more likely to die of stroke. At the present time, I am not aware of any studies done particularly in women of Indian Descent, but based on clinical experience, their risk is considered the same if not greater.
Previous heart attack or stroke or TIA — Women who've had a heart attack are at higher risk of having a second heart attack. 14 percent of persons who survive a first stroke or heart attack will have another within a year. A transient ischemic attack (TIA or "mini-stroke") also is a risk factor and predictor of stroke.

Controllable Risk Factors:

Tobacco smoke — Smoking is the single most preventable cause of death in the United States. Smoking is a major cause of cardiovascular heart disease among women. Women who smoke have an increased risk for ischemic stroke and subarachnoid hemorrhage. Constant exposure to others' tobacco smoke (secondhand smoke) at work or at home also increases the risk, even for nonsmokers.Women smokers who use birth control pills have a higher risk of heart attack and stroke than nonsmokers who use them. 
High blood cholesterol — High blood cholesterol is a major risk factor for heart disease and also increases the risk of stroke. Studies show that women's cholesterol is higher than men's from age 45 on. High levels of LDL (low-density lipoprotein) cholesterol (the "bad" cholesterol) raise the risk of heart disease and heart attack. High levels of HDL (high-density lipoprotein) cholesterol (the "good" cholesterol) lower the risk of heart disease. Research has shown that low levels of HDL cholesterol seem to be a stronger risk factor for women than for men. 
High blood pressure — High blood pressure is a major risk factor for heart attack and the most important risk factor for stroke. Women have an increased risk of developing high blood pressure if they are obese, have a family history of high blood pressure, are pregnant, take certain types of birth control pills or have reached menopause. African-American women have higher average blood pressure levels compared to Caucasian women. 
Physical inactivity — Various studies have shown that lack of physical activity is a risk factor for heart disease and indirectly increases the risk of stroke. Overall, they found that heart disease is almost twice as likely to develop in inactive people than in those who are more active. When you're inactive and eat too much, you can gain excess weight. In many people overweight can lead to high blood cholesterol levels, high blood pressure, diabetes and increased risk of heart disease and stroke. The American Heart Association recommends accumulating at least 30 minutes of physical activity on most or all days of the week. 
Obesity and overweight — If you have too much fat — especially if a lot of it is located in your waist area — you're at higher risk for health problems, including high blood pressure, high blood cholesterol, high triglycerides, diabetes, heart disease and stroke. 
Diabetes mellitus — Compared to women without diabetes, women with diabetes have from two to six times the risk of heart disease and heart attack and are at much greater risk of having a stroke. People with diabetes often have high blood pressure and high cholesterol and are overweight, increasing their risk even more. 

What has been challenging in treating women with suspected heart disease is the simple fact that women feel heart pains differently than men. This has led to many missed diagnosis (as we are trained to look for a particular symptom complex). Also, there has been a prevalent thought, that somehow women have some native protection from heart disease due to the hormone estrogen. There may be some protection earlier in life, however, its not enough to compensate for the other risk factors. Women seem to have more risk associated with the traditional risk factors than men. For example, men and women with diabetes have an increased risk of heart disease, however, proportionately women with similar risk factors are at a greater risk than a comparable group of men. 

Heart disease can be a very silent disease and may not be diagnosed until some diagnostic test or procedure is performed. In future articles, I will be discussing different tests used to assess risk for heart disease. With increasing attention on preventing heart disease in women, we expect to see a decline in the number of women having heart attacks and stroke.


*Disclaimer: The contents are meant for informative, educational purposes only. Formal recommendations can only be made by physicians involved in your care. Please check with your physician before acting on any part of this article.