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While young women are less prone to heart conditions than men, the risk increases after menopause, becoming roughly equal to that for men in the same age group. Heart disease is a leading cause of death among postmenopausal women – much more so than breast cancer and fractures, two common conditions affecting women over 60. The relative immunity from heart disease during a woman’s reproductive years may be in part due to the protective effect of the female hormone estrogen. But after menopause, declining estrogen levels combined with conditions such as aging, unhealthy lifestyles and other risk factors (such as diabetes) significantly increases the rate of heart disease – coronary artery disease (CAD) being the most common kind. Affected women are also more at risk of dying from heart disease as compared to men, with mortality almost twice that for men with the same condition. For a woman around the menopausal stage, risk factors for CAD are of two kinds: Non- modifiable: These include age, gender and genes. Modifiable: These include life style and presence of conditions that are risk factors. Some of these are discussed below: Symptoms The symptoms of CAD in women can be different from for men.

Unlike men, women who suffer a heart attack or  myocardial infarction (MI) may experience no chest discomfort or pain in the days or weeks leading up to the MI. They do, however, commonly report afterwards having experienced a hot or burning sensation or even tenderness in the back, shoulders, arms or jaw. Other early warning symptoms of an impending MI include unexplained fatigue, sleep disturbances, breathlessness, indigestion, anxiety, sweating, abdominal pain and nausea or vomiting. Chest pain, when present, is likely to be described as a sensation of pressure or tightness rather than as pain. Women also experience silent MIs (a heart attack without symptoms) more often than men. Survival rates for women after an acute MI are lower than those for men as their symptoms are not treated aggressively enough because they are atypical and misleading. Sudden cardiac deaths thus occur more frequently among women as their condition is not diagnosed in time. Women also tend to ignore their symptoms and do not seek prompt medical attention, mistaking their symptoms as being related to fatigue or ill-health due to other reasons.

Moreover, routine tests for CAD like the treadmill test or an angiography may not provide convincing evidence of heart disease when carried out on women and may even be misleading. The role of hormones may be one reason for this. Treatment and prevention Treatment of CAD consists of lifestyle modifications and medication for the treatment of conditions that cause the disease, such as high blood pressure, diabetes and dyslipidemia. Other drugs which may be used are nitrates which help to relax the muscles of the heart, improving its supply of oxygen-rich blood and aspirin which helps prevent the formation of blood clots within blood vessels. Invasive procedures may be required if these measures are ineffective. These include a coronary angioplasty followed by stenting (which helps recanalize coronary blood vessels) or a bypass grafting. The latter involves grafting a healthy blood vessel from the chest or leg to circumvent blood flow to the heart around the narrowed artery. Due to the protective effect on the heart of the female hormone estrogen, hormone replacement therapy or HRT has been found to lower the risk of CAD in postmenopausal women.

However, the efficacy of HRT in preventing CAD events in women who have already developed heart disease is doubtful. There are several things you can do to lower your risk of developing CAD after menopause. Exercise regularly – at least half an hour of moderate exercise on most days of the week is advised. Bring your weight under control if you are overweight or obese. Modify your diet to reduce its fat and cholesterol content, and use only heart-healthy fats such as sunflower oil in the cooking of your food. Eat a balanced diet rich in fruits, vegetables, whole grains, legumes and heart-healthy foods such as fish, walnuts, and low fat dairy products. Go for a medical checkup every year as this helps modifiable risk factors to be detected in time and brought under control. The importance of giving up smoking cannot be overemphasized.

Keeping stress at bay through yoga and meditation also helps protect your heart against heart disease.

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