Ladies First: Is this also true in case of death after heart attack?

 

A recent study presented at Heart Failure 2023, a scientific congress of the European Society of Cardiology (ESC) has claimed that women are twice more likely to die after a heart attack than men ( ref ). 

India is currently known as the capital of heart disease. As per the report published in the Times of India nearly 25% of all the deaths taking place in the country are due to heart diseases. In this percentage, women account for a significant number. The Global Burden of Disease Study revealed that 18% of female deaths are due to heart diseases like a heart attack ( ref ). The terrifying aspect of this percentage is that in India women die more from heart disease than cancer. This is also true for people belonging to all origins and ages. As per the data published by the Centers for Disease Control and Prevention in 2017, 21.8% of women died due to heart disease, whereas, cancer accounted for 20.8% of deaths ( ref ). Furthermore, the mean age of heart attack in Indian women is 59 years. This is much lower than the average of women suffering from heart attacks in developed countries ( ref ). This signifies the severity of the situation in our country. 

Possible reasons for increase in the risk of death after heart attack in women

Referring back to the recent study, it can be found that smoking is one of the major reasons that is succumbing young Indian women. The increasing acceptance of smoking among women in India has led to a significant rise in the number of heart diseases in women. A study conducted on Indian females to understand the variations in the patterns of tobacco usage revealed that the use of tobacco among women is less, yet they bear the burden of tobacco-related disease and mortality. In this, the tobacco industry is mostly to be blamed for the initiation of the tobacco epidemic as they have been targeting young women through their advertisements. However, a point to note here is that smoking has always been a part of men’s daily routine. This is the reason why a significant deviation is not observed in the rate of men being victims of heart attack-related deaths.

The second reason that has been highlighted in the study is post-menopausal condition. After menopause, women bear worse short and long-term outcomes after heart attack than the men of similar age. Dr. S. B. Gupta, a cardiologist not involved in the study said,

“After the age of 45 years, when a woman achieves menopause then incidence of heart attack is same in both men and women.”

Many studies have attempted to illustrate the underlying mechanism behind this association. These attempts have revealed that estrogen shows a cardioprotective effect by maintaining high levels of good cholesterol and low levels of bad cholesterol. Thus, with menopause estrogen level decreases significantly (ref: Pardhe, B.D., Ghimire, S., Shakya, J., Pathak, S., Shakya, S., Bhetwal, A., Khanal, P.R. and Parajuli, N.P., 2017. Elevated cardiovascular risks among postmenopausal women: a community based case control study from Nepal. Biochemistry research international, 2017.). This, in turn, makes women more prone to cardiovascular diseases like heart attack. 

Despite these findings, many women are not even aware that post-menopause they could also be the victim of heart disease. Moreover, they take maximum time to call for help on experiencing any form of discomfort (ref: Bugiardini, R., Ricci, B., Cenko, E., Vasiljevic, Z., Kedev, S., Davidovic, G., Zdravkovic, M., Miličić, D., Dilic, M., Manfrini, O. and Koller, A., 2017. Delayed care and mortality among women and men with myocardial infarction. Journal of the American Heart Association, 6(8), p.e005968.). This is the reason why they do not get timely help. As we know time is muscle in cardiac health; thus, getting on-time help is crucial to combat heart diseases. Even after receiving the treatment, women, compared to men, are at higher risk of rehospitalisation within a year due to coronary-related complications. The identified risk factors contributing to this were obesity, heart failure, and depression (ref: Sawano, M., Lu, Y., Caraballo, C., Mahajan, S., Dreyer, R., Lichtman, J.H., D’Onofrio, G., Spatz, E., Khera, R., Onuma, O. and Murugiah, K., 2023. Sex difference in outcomes of acute myocardial infarction in young patients. Journal of the American College of Cardiology, 81(18), pp.1797-1806) However, the dilemma of the situation is that none of the women were hospitalised for these non-cardiac factors. This exemplifies the negligence shown by women towards their overall health. In turn, it contributes to the development and progression of co-morbid conditions. Thus, lack of self-care is evidently one of the possible reasons that make women more prone to mortality than men even after heart attack.

Tips to prevent heart attack related deaths in women

Considering the above findings, it is necessary that proactive measures must be developed and implemented. In this, it is crucial to educate women about the significance of taking care of their health, while emphasising the gravity of not ignoring even simpler symptoms. Other than this, care after heart attack treatment is also a must. In this, cardiac rehabilitation program can help a lot. It is a program designed to support the overall well-being and quick recovery of the patient post any cardiac procedure. This can start either while the patient is in the hospital or right after the person leaves the premises of the health centre. This program lasts for 2 to 3 months and provides the following benefits:

• Strengthens the heart and body after heart attack.
• Relieves the symptoms of heart problems, such as chest pain.
• Habituates the patient with healthier habits like doing more physical activity, quitting smoking, and eating a heart-healthy diet.
• Aids to reduce stress.
• Increases the energy level and facilitates an easier transition to daily activities like carrying groceries and climbing stairs.
• Makes the patient more likely to take the prescribed medicines, a need to prevent further complications.

Thus, it is essential to encourage women to participate in a cardiac rehabilitation program. This will not only let them to be aware of their condition but also self-manage themselves. In turn, it will also reduce hospitalisation because of avoidable complications after heart attack. 

It’s never too late to start a health revolution. Awareness is the only way by which heart attack patients could be saved from facing any further unnecessary complications. 

Do share your views on how we can prevent death among heart attack patients.