February is heart disease awareness month. It is an issue dear to my heart and one of the several reasons I became a cardiologist. I will use the umbrella term “cardiovascular heart disease” as it encompasses both the heart and the many blood vessels that take blood from it to the rest of the body.
Cardiovascular heart disease (CHD) is the number one killer in women worldwide. A woman dies every minute from cardiovascular disease, this more than breast cancer and all types of cancer combined, yet few women are aware of this fact. Regrettably, this has not translated to increased worldwide awareness. Heart disease is still viewed as a “man” disease or a “western country” problem. In reality, it disproportionately kills more people than HIV/AIDS in sub-Saharan Africa daily. Not to underestimate the issue, heart disease is also the number one killer in men worldwide.
Manifestation of heart disease occurs when there is a complete occlusion of the blood vessels; this deprives oxygen and blood flow to that particular organ and in turn leads to myocardial infarction (heart attack), stroke (brain attack) and congestive heart failure/cardiomyopathy (weak pumping heart). However, there are other causes of heart disease that are peculiar to women; diseases like rheumatic heart disease and peripartum cardiomyopathy, which I will discuss later, are extremely dangerous in young women of childbearing age.
Traditional risk factors like diabetes, high blood pressure, obesity, high cholesterol, excessive alcohol and tobacco use, high-fat dietary choices and physical inactivity account for about 61% of cardiovascular deaths worldwide. Other risk factors for heart disease in women include stress, pregnancy related diabetes and hypertension, preeclampsia and menopausal state. Of note, infectious disease due to rheumatic fever and human immunodeficiency disease (HIV) can cause associated cardiomyopathies.
Estimated 319,400 deaths worldwide is due to rheumatic heart disease. This can be especially life threatening in pregnant women who may be unaware of prior damage and then, the additive demand on the heart by pregnancy to nourish the developing baby can then lead to fatal outcomes.
Peripartum cardiomyopathy, also known as pregnancy-associated cardiomyopathy (heart weakness), is very prevalent in Nigeria and occurs about 1 in 10 pregnancies. The reason for this heart weakness is not known. It is advised that women with cardiomyopathy and severe valve damage avoid future pregnancies and be under the care of a cardiologist long-term.
One of the key reasons women are dying from cardiovascular disease is that symptom presentation is different from the typical heart attack symptoms men display. In fact, some women may not have symptoms at all. 2 out of 3 women who die of heart disease have NO warning signs at all. Others may have atypical symptoms like jaw, throat and back pain, but a good amount will still have chest pain (typical) with physical activity. Chest pain can also be associated with fatigue, nausea/vomiting and diaphoresis. If you have any of these symptoms, go see your doctor as soon as possible or present to the hospital. Furthermore, women are more likely to focus on the health of their spouse, children and families, and at times neglect their own health and self-care.
How can I reduce my chance of heart disease? The most important advice is to know your numbers.
- Know your blood pressure. Having uncontrolled and untreated blood pressure is the most common reason for heart disease in Africa. High blood pressure has no symptoms, so it is important to have your blood pressure checked regularly. Importantly if you have high blood pressure, take your medication consistently. A good blood pressure reading is numbers less than 130/80 majority of the time.
- Know your blood sugar numbers. Make sure you are tested for diabetes especially if you have family members with diabetes. If you have diabetes, stay on top of your sugar control.
- Know your cholesterol numbers, most especially your LDL (bad cholesterol). Avoid or minimize your intake of fried food, butter, red meats and palm oil.
- Know your weight. Start physical activity and perform moderate cardio physical activity for 20 minutes a day three times a week. Also, incorporate healthy food choices. Eat more fresh vegetables, fish and chicken. Avoid processed food, soft drinks, sugar and fast foods. Restrict your salt intake to less than 2 grams per day. Reduce use of seasoning cubes (MAGGIE and KNOW cubes).
- Limit how much alcohol you drink to one drink a day.
- Manage stress levels by finding healthy ways to cope with stress.
- If you smoke, QUIT smoking as soon as possible.
In summary, cardiovascular disease (heart disease) is easily preventable and we can reduce death related to it dramatically if the above steps are implemented. It starts with educating our communities about heart disease awareness in women. Most importantly, we need to be our own self-advocate and create time for self-wellness and self-care.
Ifeoma Onuorah Ezenekwe is an Assistant Professor with the Division of Cardiology at Emory University School of Medicine Atlanta Georgia since 2017. Prior to joining Emory University, she worked as an attending cardiologist at the WJB Dorn VA, Columbia South Carolina where she also held the title of Clinical Assistant professor with the University of South Carolina Medical school. Dr Onuorah Ezenekwe obtained her Bachelor's of Science in nursing from the University of Texas Medical Branch Galveston graduating with high honors. She completed her medical school training at the University of Texas, San Antonio and was inducted into Alpha Omega Alpha honor society (AOA) at graduation. She completed her Internal Medicine residency training at the prestigious John Hopkins’s Osler training program in Baltimore Maryland and General Cardiology Fellowship at Thomas Jefferson University Hospital, Philadelphia Pennsylvania.