Taking Care of Your Heart: Heart health for middle-aged women
At Stix, we know that cardiovascular health plays an important role in your quality of life and overall wellbeing. So, we’ve partnered with Dr. Nedda Dastmalchi, DO, MA, a physician and cardiology fellow at Temple University Hospital in Philadelphia, to get real about heart health in honor of Heart Month.
In the third installment of our Taking Care of Your Heart series, we chatted with Dr. Dastmalchi about heart conditions that overwhelmingly affect women, including SCAD and MINOCA. Here’s what we learned.
What is a SCAD heart attack? Why should women know about it?
Dr. Dastmalchi: Sudden coronary artery dissection (SCAD) is a type of heart attack that’s not like a typical heart attack where a clot or plaque (which leads to atherosclerosis) causes poor blood flow to the heart muscle. Instead, SCAD is caused by a tear to one of the layers of the arteries that supply blood to the body, which reduces the amount of oxygen feeding the heart muscle.
This condition typically affects women in their 40s and 50s and overwhelmingly occurs in women more than men. It is thought to be the leading cause of heart attacks in those under the age of 50. SCAD is also the most common cause of heart attacks in pregnant women. What makes this type of heart attack unique is that it affects those who often don’t have risk factors for cardiovascular disease, including diabetes, high blood pressure, or high cholesterol.
What causes SCAD? What signs or symptoms of SCAD should women look for?
Dr. Dastmalchi: A trigger such as extreme exercise, a prior health condition that affects your vessels, elevated blood pressure, emotional distress, drug use, or hormonal treatment can lead to stress on the walls of your heart and cause a tear. Approximately 20% of cases are without a known cause.
The symptoms of SCAD are similar to having a heart attack: chest pain or pressure is most common. SCAD can be associated with pain down the arms or up the jaw, shortness of breath, and heart palpitations, also known as abnormal heart rhythms.
What are the risk factors for SCAD?
Dr. Dastmalchi: Some risks are thought to be fibromuscular dysplasia, multiple pregnancies, drug use, connective tissue disorders, such as Ehlers-Danlos and Marfan's syndrome, systemic inflammatory diseases, and hormone therapy. Among pregnant women, the thought is that the increased stress to the body and/or hormonal changes may weaken the wall of the vessels. Multiple pregnancies can also increase the risk of SCAD because of the repeated stress and hormonal changes that affect the body.
Can SCAD be prevented?
Dr. Dastmalchi: The risk factors cardiologists screen for heart disease — such as high cholesterol, high blood pressure, diabetes, and smoking — are not always attributed to SCAD. Additionally, known coronary artery disease is also not found to be a contributor to this type of heart attack either. After you are diagnosed with SCAD, patients are advised to stay away from triggers, heavy lifting, and over-exertion for a period of time. Some may be referred for cardiac rehabilitation.
What is MINOCA? Why should women know about it?
Dr. Dastmalchi: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a condition that predominantly affects women at a rate of almost 5x that of men. MINOCA is a type of heart attack that’s unlike a common heart attack where a clot or plaque causes poor blood flow to the heart. Instead, MINOCA is a heart attack where there is less than 50% blockage in the arteries, which means the blockages are not large enough to cause a typical heart attack.
MINOCA heart attacks make up approximately 5-10% of all heart attacks and are found to occur at a younger age than heart attacks caused by plaque buildup.
What causes MINOCA? What signs or symptoms of MINOCA should women look for?
Dr. Dastmalchi: Research is still ongoing to understand the causes of MINOCA; however, some known causes include a small clot or spasm of the coronary arteries that leads to decreased blood flow to the heart. The symptoms of MINOCA are similar to a heart attack:
- Chest pain or pressure
- Potential pain down the left arm
- Palpitations (abnormal heart rhythm)
- Difficulty breathing
Since this syndrome is still being studied, risk factors are not well understood. Research shows that MINOCA occurs at a younger age than a heart attack from plaques and that patients don’t have high cholesterol levels or a history of diabetes. This condition has also been found to affect Black, Hispanic, and Pacific Islander women more than other ethnic groups of the same gender.
To help prevent heart conditions more broadly, lifestyle choices are always important and key in keeping your cardiovascular system healthy. Moderate exercise with 30 minutes of cardio 5 times a week can aid in the prevention of heart disease, along with adopting a well-balanced diet full of vegetables, fruit, unrefined grains, and heart-healthy fats.
How does heart health become an important factor after your reproductive years?
Dr. Dastmalchi: Women have an exponential rise in the risk of heart disease later in life than men as a result of falling levels of estrogen during perimenopause and postmenopause. Additionally, there is a change in fat distribution and lipid content that further increases your risk.
It’s important to note that ethnicity and race play a role in the onset of menopause, or the age at which women reach menopause. Black and Hispanic women experience menopause at a younger age whereas Japanese women experience it at an older age on average. As a result, screening for cardiovascular risk factors is essential throughout your life — not just once you reach middle age.
Don’t miss a beat this Heart Month. Stay tuned for more heart health education throughout the month of February.
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