Health campaigners have previously played on the caring wife and mother to increase the awareness of many health issues. But when it comes to heart disease, it is time for women to start looking after themselves.
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Most Australians know that being overweight and smoking aren't good for your heart. Most Australians know that being diagnosed with high blood pressure, high cholesterol or diabetes increases your risk of developing heart disease. And it's true, high blood pressure is the single largest risk factor for cardiovascular disease. But for women in particular, there are many other risk factors that don't get the recognition they deserve.
Ischaemic heart disease (also known as heart attacks) is the leading cause of death in women worldwide. Yet most Australian women don't realise that heart disease is something that affects them. Women are relatively protected from heart disease before menopause because of the high levels of oestrogen in their bodies. Oestrogen acts to reduce "bad" cholesterol (LDL), increased "good" cholesterol (HDL) and stabilise any cholesterol in the walls of the heart arteries to reduce the risk of heart attacks. However, after menopause - usually around the age of 51 - this protection suddenly declines. The cardiovascular risk profile of post-menopausal women then accelerates for 10 years until they have the same risk as men.
The National Vascular Disease Prevention Alliance created a heart disease risk calculator based on age, gender, blood pressure, smoking, cholesterol, diabetes and heart tracing. Doctors use this to decide if a patient's risk profile warrants medication. But it's not the whole story - especially when it comes to women. It is not well known that what happens in pregnancy influences a woman's risk of heart disease for the rest of her life.
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High blood pressure and pre-eclampsia related to pregnancy increases a woman's risk of heart disease later in life. In a very large study of 1.3 million women in the UK over 20 years, women with pregnancy-related hypertension had double the risk of dying from heart disease. These women were more likely to develop high blood pressure outside of pregnancy, and do so at a younger age. Similar trends are seen with diabetes. Half of the women who have diabetes in pregnancy go on to develop diabetes in the next five to 10 years. And it's not just women that are affected - babies of mothers with pregnancy-related high blood pressure and diabetes are more likely to be obese or develop diabetes themselves.
Having a baby that is growth-restricted or premature also increases the likelihood of a mother having heart disease later in life. But none of these pregnancy-related factors are routinely considered when doctors calculate heart disease risk. Doctors should start asking and women should start talking about their pregnancies to better understand their heart disease risk.
This February, the RedFeb campaign is raising awareness about heart disease, and this year the focus is on heart disease in women. Women are encouraged to speak with their doctor and share their pregnancy history to better understand and manage their risk of heart disease. Heart Research Australia asks all Australians to wear red and donate to groundbreaking research. We want to support researchers to keep improving the identification, prevention and management of heart disease in Australia, especially among women.
Heart disease in women doesn't get the publicity it deserves, it's time to change that.
- Dr Ashleigh Dind is a cardiologist at Royal North Shore Hospital.
- For more information or to donate, visit heartresearch.com.au