Are you underestimating your risk of heart disease?

Heart disease is often referred to as the silent killer — with coronary heart disease being the single most common cause of death before 65 [1]. Coronary heart disease can be prevented — if you know your risks and how to reduce them.  

In this blog, we look at:  

• What is heart disease?  
• The signs and symptoms of heart disease 
• Are you at risk of heart disease? 
• The gender gap – women and heart disease 
• How to reduce your risk of heart disease  

What is heart disease?

Heart disease or cardiovascular disease (CVD) refers to any condition affecting the heart or vessels of the heart, including abnormal heart rhythms, heart failure, and valve problems. Within this category are more specific conditions, such as coronary artery disease — this is where there is a build-up of fatty deposits inside the arteries supplying the heart, which can lead to heart attacks and strokes. Coronary artery disease is also known as ischaemic heart disease or coronary heart disease.   

Mistakenly, coronary heart disease is often thought of as more of a male condition. In 2019, it was the most common cause of death among women worldwide, so everyone needs to be aware of their risk and the signs and symptoms of heart disease.  

The signs and symptoms of coronary heart disease

When the arteries supplying the heart become blocked, the heart’s supply of oxygen is reduced which can lead to temporary or permanent damage. In the early stages, of coronary heart disease, you’re unlikely to notice anything. 

Often, the first symptoms of a blockage happen during exercise, when the heart needs more oxygen. We call this type of chest pain angina — it’s an important warning sign that you may be at increased risk of a heart attack or stroke. 

Symptoms of angina include:  

• Chest pain, particularly on exertion or during times of stress — sometimes it radiates to the arms, neck or jaw 
• Feeling sick or breathless 
• Feeling faint  

Are you at risk of heart disease?

There are several risk factors for developing cardiovascular disease, including:  

• Having a family history of early cardiovascular disease  
• Having high cholesterol  
• Being overweight or obese  
• Having diabetes  
• Smoking  
• Eating an unhealthy diet, high in saturated fats and ultra-processed foods 
• Being physically inactive  

Your gender could also, possibly, be seen as a risk factor, as men are more likely than women to have a heart attack. And they tend to develop coronary heart disease earlier.  

However, over time, this information has led to a misconception that women’s cardiovascular risk is low, or even non-existent. So much so, that women may be less likely to seek medical attention when they are having a heart attack, which can lead to worse outcomes – in the UK, women are twice as likely to die of coronary heart disease as they are of breast cancer [2]. 

How common is heart disease in women?

Recent studies have shown that there are clear and significant sex disparities when it comes to the presentation, management, and outcomes of women with heart disease [3].  

Even though, on average, women may have fewer heart attacks than men, women may be less likely to seek medical attention or be slower to present, which significantly affects the chances of survival [4]. 

It’s likely men and women experience heart attacks differently. In both sexes, chest pain is the most common symptom, but women may be more prone to other symptoms such as shortness of breath, nausea, vomiting, and back or shoulder pain [5], which may be why a UK study found that misdiagnosis was more common in women [6].  

The British Heart Foundation found that key heart attack symptoms were similar for both sexes — although women more commonly experienced back pain and nausea, and men were more likely to experience heartburn symptoms [7]. As well as higher rates of misdiagnosis, there is evidence to suggest that women are also more likely to be undertreated for cardiovascular disease compared to men [3,5].  

There is a positive though – as a woman, hormones can give you some protection from heart disease in your pre-menopausal years [8]. However, as you get older, it becomes increasingly important to be aware of the risk factors above.  

The British Heart Foundation recommends that all women over the age of 40 should visit their local GP or nurse for a health check to measure their risk of cardiovascular disease. Your doctor should invite you to review your risk every five years as part of an NHS Health Check. 

Regardless of your risk, there are ways to reduce it (or keep it low) through some simple lifestyle changes.  

5 ways to reduce your risk of heart disease

1. Eat a healthy, well-balanced diet

A low-fat, high-fibre diet is recommended, which should include plenty of fresh fruit and vegetables (five portions a day) and wholegrains.   

You should also limit your salt intake to no more than 6g per day and avoid too much sugar. Discover more ways to optimise your diet in our blog: eat to beat heart disease.  

2. Get moving more

Incorporating physical activity into your daily routine is the best way to maintain a healthy weight. Being a healthy weight can reduce your chances of developing high blood pressure.   

Simple changes, such as taking the stairs instead of the lift or parking a little further away from work, can help to increase your physical activity. To help, we’ve also put together some tips on how to get moving more without going to the gym.  

3. Give up smoking

Smoking is a major risk factor for heart disease as it can cause the arteries to become clogged with fatty substances called plaques.   

Giving up smoking using free services such as NHS Smoke Free along with stop-smoking medicines, such as patches or gum, can reduce your risk of developing heart disease.  

4. Keep an eye on your blood pressure

Eating a healthy diet low in saturated fat and salt, exercising regularly, and (if needed) taking medicine to lower your blood pressure can help you keep your blood pressure under control.  

Your ideal blood pressure should be between 90/60 mmHg and 120/80mmHg. If it’s more than 140/90mmHg, you’re likely to have high blood pressure, so you should discuss this with your GP.   

You can read more about high blood pressure in our blog: high blood pressure: causes, risks, and prevention.   

5. Keep your diabetes under control

Having diabetes can put you at greater risk of developing heart disease. Being physically active and controlling your weight and blood pressure will help manage your blood sugar level.  

Where to get more information 

• The British Heart Foundation has a Heart helpline that you can call to talk to someone about any worries you may have. It also has a supportive online community, as well as a Heart Matters magazine.  
• Your GP – your GP or nurse will be able to give you more information about your risk factors.  

How can I check my risk of heart disease?

Our Heart Disease Risk Blood Test looks at the main risk factors for heart disease including cholesterol and high sensitivity CRP - a measure of damaging inflammation. With a heart disease blood test, a doctor will interpret your results alongside your health and lifestyle information to assess your risk and give you advice on your next steps. 

References  

1. British Heart Foundation. 2022. Heart Statistics. [online] Available at: <https://www.bhf.org.uk/what-we-do/our-research/heart-statistics> [Accessed 10 October 2022]. 
2. Women and heart disease (no date) British Heart Foundation. Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease (Accessed: January 23, 2023).  
3. Liakos, M. and Parikh, P.B. (2018) “Gender disparities in presentation, management, and outcomes of acute myocardial infarction,” Current Cardiology Reports, 20(8). Available at: https://doi.org/10.1007/s11886-018-1006-7. 
4. Women and heart attacks (no date) British Heart Foundation. Available at: https://www.bhf.org.uk/informationsupport/conditions/heart-attack/women-and-heart-attacks (Accessed: January 23, 2023). 
5. Woodward, M. (2019) “Cardiovascular disease and the female disadvantage,” International Journal of Environmental Research and Public Health, 16(7), p. 1165. Available at: https://doi.org/10.3390/ijerph16071165. 
6. Wu, J. et al. (2016) “Editor’s choice - impact of initial hospital diagnosis on mortality for acute myocardial infarction: A national cohort study,” European Heart Journal: Acute Cardiovascular Care, 7(2), pp. 139–148. Available at: https://doi.org/10.1177/2048872616661693. 
7. British Heart Foundation (no date) No difference in key heart attack symptoms between men and women, BHF. British Heart Foundation. Available at: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/august/no-difference-in-key-heart-attack-symptoms-between-men-and-women (Accessed: January 23, 2023). 
8. Women and heart attacks (no date) British Heart Foundation. Available at: https://www.bhf.org.uk/informationsupport/conditions/heart-attack/women-and-heart-attacks (Accessed: January 23, 2023).