We have known for a long time that high blood pressure, high cholesterol levels, being obese, having diabetes, your genetic makeup and smoking are risk factors for developing a heart attack. Also, the common presumption that only men have heart attacks is untrue. Women can have a heart attack just like men, but sometimes the symptoms women experience may be different to men. People having a heart attack usually experience chest pain associated with breathlessness, sweatiness, severe fatigue, nausea, and anxiety, but this can vary a great deal in any individual, especially in women. The lack of awareness and differences in presentation, sometimes delay women from getting appropriate medical help early. Increasing awareness of the possibility that a woman can have a heart attack may motivate women to both prevent this by reducing their risk factors and seeking help early if they feel this is suddenly happening to them. Research shows us that the earlier a person presents to a hospital for medical help after the onset of a heart attack, the better the chance of full long-term survival.
Pregnancy is a good time for doctors to identify women who may be at increased risk of a heart attack. It is a time when women can learn about their health and how to have a healthy lifestyle that prevents a heart attack. In addition to the usual risk factors, research has shown that women who develop some pregnancy complications have a higher risk of suffering a heart attack prematurely.
Pregnancy as a window of opportunity to identify risk for heart attack
A woman’s body goes through many changes during pregnancy and some of these changes can cause stress on the heart and blood vessels. Although these changes are all normal responses to pregnancy, sometimes they lead to pregnancy complications. 3-4% of women develop high blood pressure and about 15% develop diabetes during pregnancy. These conditions most often go away after pregnancy, but research shows that some women who develop these pregnancy complications are at higher risk of a heart attack in later life. Recent research shows that women who have hypertension during pregnancy or preeclampsia (hypertension during pregnancy with protein in urine and involvement of some other organs of the body) are two times more likely to have high blood pressure, heart attack or stroke compared to women who do not have hypertensive diseases in pregnancy. About half of all women who have diabetes during pregnancy (gestational diabetes mellitus) go on to develop type 2 diabetes within 10 years and are also about twice as likely to develop heart attacks compared with women who do not develop diabetes during pregnancy. In addition, women who deliver before the completion of 37 weeks gestation (preterm delivery), are also twice as likely to have a heart attack in later life compared to women who deliver after the completion of 37 weeks gestation. There is also some research that shows women who have very small babies (called growth-restricted babies) may also be at higher risk of heart disease.
What can we do to reduce the risk of a heart attack after pregnancy complications?
As we all know, most of the risk for heart attack can be reduced by making lifestyle changes to be healthier. Simple changes including eating more fruits and vegetables, reducing high-fat and high-sugar food, doing some exercise every day (including walking), stopping smoking, and keeping body weight in a healthy range will help reduce the risk of a heart attack. Also, getting your blood pressure, blood sugar and blood cholesterol levels checked regularly will help your doctor to identify these risk factors early so that your doctor can advise you on how to treat these problems and reduce your risk of heart disease.
Associate Professor Margaret Arstall
Director of Cardiology
Northern Adelaide Local Health Network
University of Adelaide