Women with Heart Disease: Living a Good Life

If you're a woman who has been diagnosed with heart disease, it doesn't mean that you've been issued a death sentence. Rather, it means that it's time to take a closer look at how you, your family and your health care providers can work together to make changes in your life to help prevent further damage to your heart.

An important first step for you and the people around you is to learn about heart disease and what you can do to maintain and improve your well-being.

What is Heart Disease?

There are many types of diseases that affect the heart One of the most common is coronary artery disease which occurs when plaque builds up in the blood vessels to the heart thereby making it more difficult for blood to get to the heart and provide it with essential oxygen.

Not Sure if You're at Risk for Heart Disease?

There are several risk factors for women that can put your heart's health at risk. Some factors you can change, and others you can't. If you are concerned, talk to a doctor or other health professional about checking the condition of your heart, and ways to reduce your risk of heart disease.

How Heart Disease affects Women

Women are more likely to develop heart disease at an older age than men do. Yet more women than men die from heart disease because the symptoms are ignored or missed. In fact, coronary artery disease is the leading cause of death for Canadian women, according to the report, The Growing Burden of Heart Disease and Stroke in Canada .

Heart disease affects women of all ages, but it's of greatest concern for women over the age of 55. The reasons why women tend to be older when they develop heart disease aren't clear. One reason may be related to a decrease in the amount of naturally occurring estrogen (a female hormone) that women experience when they enter perimenopause. This naturally occurring estrogen appears to help protect women from heart disease.

Until recently, researchers thought that if menopausal women took supplemental estrogen through hormone therapy to combat the decrease of naturally occurring estrogen, they would continue to experience a reduced risk of heart disease. However, research has since shown that taking estrogen in fact increases a woman's risk of heart disease. As a result of these studies, hormone therapy isn't recommended anymore to prevent heart disease.

Listen to your Heart

When it comes to the warning signs of heart disease, angina and a heart attack, women are more likely to feel vague chest discomfort rather than a sharp pain or tightness like men feel.

But the milder symptoms don't mean that a woman's heart problems are any less severe than a man's.

Watch for Signs and Symptoms of Angina and Heart Attack

• Chest pain, which may include feelings of:
  • tightness
  • discomfort
  • crushing pain
  • heaviness
  • pressure
  • squeezing
  • fullness
  • burning.
• Spreading pain, which may spread out in one or more of the following ways:
  • from the chest area
  • down one or both arms
  • to the neck, jaw or shoulders.
• Shortness of breath
• Paleness, sweating or overall weakness
• Nausea, vomiting and maybe indigestion
• Anxiety, fear or denial

If you notice any of these symptoms:

• Tell someone
• Call 911 or your local emergency number.

Other Risk Factors for Women

It may also be that at this stage in their lives, women have other risk factors that can affect heart health, like being overweight or being less physically active.

Having high blood pressure or diabetes are other risk factors that increase women's risk of heart disease up to four times and five times respectively.¹ Often, older women have more than one of these risk factors, which further increases their risk of heart disease.

One out of three women who have had a heart attack is likely to have a second heart attack.² To reduce the risk of making their heart condition worse, women with heart disease need to manage the risk factors over which they have control.

Key Challenges for Women with Heart Disease

Structure of the Heart

Many tests and treatments for heart disease were developed based on research about men. But physical differences between men and women make some tests less reliable and some treatments less effective for women.

For example, women's and men's hearts aren't the same; they often differ in size and the blood vessels of a woman's heart are sometimes narrower and more curved. This can make surgery and other treatments more difficult in women with heart disease. As more and more research focuses on women, there will be new treatment options for women.

Heart Attack Recovery

Women are more likely than men to have a second heart attack.² They are also 16% more likely to die in hospital in the first 30 days after a heart attack than men are, according to a new report from the Canadian Institute for Health Information.

Depression

Women with heart disease are at high risk of experiencing depression. Some researchers believe that depression causes irregular heartbeats and problems with blood clotting.

Since depressed individuals often find it difficult to exercise, eat a healthy diet or quit smoking, their risk of developing heart disease may increase. Also, women with depression are more likely to die from heart disease than other women.

Life Balance

Women with heart disease often feel torn between caring for themselves and juggling their hectic lives. In general, women continue to do the majority of housework, even if they work outside of the home, and are often the primary caregivers of children and ill or elderly family members.

Women with heart disease may have to make changes that also affect the lives of their families, such as making different, heart-healthier meals or doing less housework while they recuperate after a heart attack. Unfortunately, women commonly feel guilty about being sick and don't take the time to care for themselves, especially if that means having to make changes at home.

Social support

Women with heart disease suffer when there is a lack of social support and they feel alone. They may feel that family and friends don't understand what they're going through. Some women also want to keep up appearances, and don't want to burden their families with their troubles.

Access to Rehabilitation

Cardiac rehabilitation programs, which are designed to help people with heart disease learn strategies to improve and maintain their heart health, are used by women much less often than men. While an explanation for this is still unclear, some reasons may be that women don't have access to transportation to get to the program, or they don't want to or can't take the time away from other responsibilities.

Groups and Programs that can Help

If you're a woman with heart disease, you might find the following helpful to getting on the road to better health:

• Social support groups: Social support groups for women with heart disease are a good place to start to give yourself a safe and understanding place to open up, and to see that you're not alone. One woman described the sense of belonging her support group gave her:

  "It was nice to have a place to go to share common feelings - somewhere that just dealt with issues common to women. I felt close to the women even though we only met once a month. I felt like I belonged."³

  Your health care provider or your local Heart and Stroke Foundation office may be able to recommend a support group in your area. Another alternative may be to find an online support group for women with heart disease, like Le Club. The website offers you a chance to connect with other women with heart disease online, and with health experts in the area of heart disease.

• Cardiac rehabilitation programs. Cardiac rehabilitation programs educate heart disease survivors about the benefits of rehabilitation and can help women overcome challenges like depression and lack of support. Some of these programs are co-ed and some are women-only. Don't be discouraged if the program in your area is not just for women. Often within these co-ed programs, there are exercise classes and discussion groups tailored just for women.

Specialized Programs for Women make a Difference

Toronto's Women's College Hospital's Women's Cardiovascular Health Initiative (WCHI) is an example of an innovative program just for women. At the WCHI, women with heart disease come together in small groups to learn about living well with heart disease. The program is designed with women's needs in mind: the small client groups provide a supportive and close environment for women who want peer support, and there are counselling sessions on topics like the risks and benefits of hormone therapies.

Jennifer Price, WCHI's Acute Care Nurse Practitioner, says the main objectives of the program are to help women 1) reach their own personal goals, such as being able to pick up their grandchildren again, and 2) make concrete physical changes that will directly improve their heart health, such as losing weight or lowering their blood pressure. Personalized fitness training and education sessions on exercise, healthy eating and stress management also help women achieve these objectives.

A women-only program like this offers participants two big benefits: support from others going through the same thing, and dedicated time to care for their heart health. As Price puts it, "It's almost like we're giving women permission to look after themselves."

And it appears that tailoring the program to meet women's needs really works. According to Price, 85% of women who participate in the WCHI complete it, compared to typical cardiac rehab programs, which often only have a 50% completion rate.

Ask your healthcare provider if there is a women-only program in your area. If not, try talking with your local hospital about starting one.

Six Healthy Choices Improve your Heart's Health

Even if you're not registered in a formal cardiac rehab program, as a woman with heart disease, you have the power to live a more heart healthy lifestyle and improve your overall health.

• Control your blood pressure.

  Keeping your blood pressure in check can help prevent damage - like tears and bulges - to the walls of your arteries and possibly slow the hardening of your arteries.

  Making healthy food choices and following your healthcare providers' directions can help to lower your blood pressure.

• Lower your cholesterol by eating healthy foods.

  In the foods you eat, there are "good" fats and "bad" fats that affect your cholesterol.

  Fats are an essential part of our diet. However, too many saturated fats and trans fats can upset your cholesterol balance and block your arteries, which exposes you to future damage. Try baking instead of frying foods, as fried foods have higher cholesterol.

• Achieve a healthy weight.

  The risk of a heart attack is three times higher in women who are overweight than in those who have a healthy weight. Talk to your healthcare provider to determine your unique healthy weight and work out a plan for achieving or maintaining it.

• Don't smoke - if you do, stop.

  By quitting smoking, you significantly reduce your risk of dying from a heart attack.

• Be physically active.

  Find an activity that you like and get moving! The heart is a muscle that needs regular exercise in order to stay healthy.

  Consult your doctor about an appropriate exercise plan for you. It may be as simple as adding dancing, going up and down stairs, or stretching to your day. Or try starting a walking group with other people in your neighbourhood. Exercise and friends are a great mix!

• Reduce your stress and take time to relax.

  Women often feel stressed, especially when they're looking after others as well as themselves. For some people, stress raises their cholesterol level and blood pressure.

  Alleviating stress by getting help with tasks when you can and taking time to relax is very important to maintaining your heart health.

  By making some positive changes in the way you live, you can reduce your risk of making your heart condition worse or suffering future heart attacks, and you will feel stronger and in greater control of your health.

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1. Management and prevention of cardiovascular disease in women. Price J.A.D. Nursing Clinics of North America. 2004; 39: 73-884.
2. You've Come a Long Way, Baby: Cardiovascular Health and Disease in Women, Problems and Prospects. Wenger N.K. Circulation. 2004; 109: 558-560.
3. Women and Heart Disease: The Treatment May End But the Suffering Continues. Arthur H.M., Wright D.M., Smith K.M. Canadian Journal of Nursing Research 2001; 33(3): 17-29.

Prepared by womenshealthmatters.ca at Women's College Hospital and Alberta Health Services. This article appeared originally on the Canadian Health Network Web site.