International women’s day is the celebration of womanhood; a day reserved to celebrate and honour all the women present in our lives –mother, sister, wife, or friend.
To celebrate this day, apart from the usual chocolates and flowers, we should empower women with the knowledge necessary to tackle one of the most common heart disease – coronary heart disease (CHD). What makes the need for this article more critical is the fact that about 90% of women have at least one factor that raises their risk for heart disease.
About coronary heart disease
Coronary heart disease is a heart condition wherein the blood vessels of the heart cannot supply adequate blood to the heart muscle leading to life-threatening complications such as heart attack and sudden cardiac arrest. CHD is also called as ischaemic heart disease or coronary artery disease.
This disease often develops due to the build-up of a waxy substance inside the blood vessels of the heart. This waxy substance, made of calcium, fat, and cholesterol, is called plaque.[3,4] The build-up of plaque results in narrowed or blocked blood vessels, resulting in insufficient delivery of blood to the heart.
Coronary heart disease in women is different than men because of menopause and different structures of the heart. Women produce a hormone called oestrogen before menopause, which helps in keeping the blood vessels flexible and provides protection against CHD. However, the oestrogen levels drop after menopause. Additionally, the size of the blood vessels and heart in women are smaller compared to that in men.
Although the diagnostic tests and treatment procedures are standard for both men and women, there are some stark differences in the risk factors and symptoms that women may experience compared to men. 
Risk factors for CHD in women
Women are more likely to have the following medical conditions that increase their risk for CHD:
- Autoimmune diseases, a condition where your immune system may produce cells that attack normal cells of the body
- Mental health problems, such as depression and stress
- Overweight and obesity
- Metabolic syndrome, a condition that develops due to the presence of the following risk factors:[3,5]
- high blood sugar
- high blood pressure
- large waistline
- low levels of good cholesterol
- high levels of a certain fat (triglycerides) in blood
The following factors increase the risk of developing CHD in both sexes; however, the risk for women is greater than they are for men:
- Mild to moderate hypertension
- Low levels of good cholesterol[3,6]
The following conditions, which are exclusively seen in women, are responsible for increased risk for CHD in women:
- History of problems during pregnancy
- Anaemia during pregnancy
- Endometriosis, a condition where the tissue that is present on the inner lining of the uterus is present on other organs[3,7]
- Premature menopause (before age 40)
In addition to the above conditions, certain factors such as the use of birth control pills also raise the risk for CHD in women.
Symptoms of CHD in women
Women may experience no symptoms of CHD, and if they do, it may be different than men. Women may experience the following symptoms in case of a heart attack:
- Pressure or tightness in the chest
- Stomach pain
Women are less likely than men to experience chest pain, which is a common symptom of a heart attack. Even if they do, its occurrence is different than seen in men. For example, women are more likely to have chest pain during resting, while chest pain worsens with physical activity in men and subsides with resting. Additionally, mental stress is more likely to trigger chest pain in women than men.
As seen above, the symptoms differ in men and women. However, CHD in women is less often diagnosed and under-treated compared to men. With this article, you will be able to identify whether you are at risk for CHD. It will allow you to have an active conversation with your doctor about your risk factors and discuss the need for further diagnosis and treatment options.
- Office on women’s health. Heart disease and women [Internet]. [updated 2019 Jan 30; cited 2020 Feb 29]. Available from: https://www.womenshealth.gov/heart-disease-and-stroke/heart-disease/heart-disease-and-women.
- Women and heart disease [Internet]. [cited 2020 Feb 19]. Available from: https://www.cardiosmart.org/Heart-Conditions/Women-and-Coronary-Artery-Disease/Understand-Your-Condition/What-Increases-Your-Risk.
- National Heart, Lung, and Blood Institute. Coronary heart disease [Internet]. [cited 2020 Feb 19]. Available from: https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease.
- National Heart, Lung, and Blood Institute. Atherosclerosis [Internet]. [cited 2020 Feb 19]. Available from: https://www.nhlbi.nih.gov/health-topics/atherosclerosis.
- National Heart, Lung, and Blood Institute. Metabolic syndrome [Internet]. [cited 2020 Feb 29]. Available from: https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome.
- Centres for Disease Control and Prevention. LDL and HDL cholesterol: “bad” and “good” cholesterol [Internet]. [updated 2020 Jan 31; cited 2020 Feb 19]. Available from: https://www.cdc.gov/cholesterol/ldl_hdl.htm.
- Endometriosis [Internet]. [cited 2020 Mar 3]. Available from: https://www.nichd.nih.gov/health/topics/endometriosis.