7 June 2013

Dr. Antoine Sarkis 
Professor of Cardiology - Faculty of Medicine, St. Joseph University, Lebanon
Cardiologist, Hotel Dieu de France Hospital, Lebanon
Yaduna - WHHC cardiologist

Myocardial Infarction (heart attack) has always been considered as a male disease. We often mistakenly think that cardiovascular diseases affect men in the majority of cases. Thus, the main studies on screening, prevention and treatment have almost all concentrated on males. Data on women remains fragmented and badly documented. However, women as well are being increasingly affected by cardiovascular diseases (stroke or infarction). In France, cardiovascular diseases kill seven times more than breast cancer. A woman out of three dies today due to a cardiovascular disease at an increasingly younger age as a result of the mounting number of female smokers while men have cut down on their consumption.

The main difference between males and females when it comes to myocardial infarction is the age of the patient when an infarction occurs. In males, the risk of infarction related to age starts at 45 while it only starts at 55 in females.

In females, the estrogen prevents fat from depositing on the lining of arteries. However, after menopause, this difference between males and females decreases. In parallel, blood pressure and cholesterol levels climb progressively after the age of 55 which increases the risks of heart diseases.

Some studies estimate that a woman has 30% less chance of having a coronary angioplasty compared to a man. Women also have 20% less chance than men of having a stress test and 40% less chance of having an angiography. Men have 42% more chance of being administrated a statin to counter the excess of cholesterol. This situation is not without consequences.

Paradoxically, when it comes to coronary diseases (the most prevailing cardiovascular diseases), women are often under-checked, under-diagnosed and under-treated. Why? Well because women often opt for medical consultation very late being unaware of the early warning signs that might be very different from those of men. Moreover, in the case of females, the risk of dying of a first heart attack is 50% while it is 30% for men that are more quickly offered medical support.

These are the warning signs that should raise a red flag:

• A sharp and intense pain in the chest, behind the sternum or breastbone (the pain may radiate up the neck and jaws and down the left arm or both arms)
• An oppressive chest pain associated with anxiety

Other symptoms are more trivial and often underestimated by patients or their doctors:

• General discomfort or fatigue
• Shortness of breath
• An unusual anxiety
• Pain in the abdomen or back, between the scapulae (shoulder blades)