Almost one in six men and one in ten women die from CHD, and there are about 2.3 million people are living with this condition in the UK, according to the British Heart Foundation.
With coronary heart disease (CHD) the problems start when the arteries that bring oxygen-rich blood to your heart, become narrowed. And this happens when atheroma – a fatty material – is deposited in the walls of your coronary arteries. Over time these deposits build up and make your coronary arteries narrower. This condition is atherosclerosis.
Learn more about atherosclerosis
As your arteries become narrower, less of your vital, oxygenated, blood gets through to your heart. When this happens you may feel pain in your chest. This is angina, a common symptom of CHD.
Atherosclerosis can also cause a more serious health problem. If a piece of the atheroma breaks away from the artery wall, it can result in a blood clot. If the clot blocks the already narrowed coronary artery, it can cut off the blood supply, and the oxygen it brings with it. When this happens it damages the part of your heart muscle that isn’t getting oxygen and causes a heart attack. The medical term for this is myocardial infarction.
If the blockage happens in one of the smaller arteries, a relatively small part of your heart muscle is likely to be affected. However, if the blockage happens in one of the large coronary arteries, a larger part of the heart muscle will be damaged.
While coronary heart disease is the main cause of death in the UK, there is some good news. In January 2015, the BMJ Open (British Medical Journal) published information from a study. It showed that between 2000 and 2007, the number of deaths from coronary heart disease in England fell by 38,000. About 20,400 of these were thanks to reductions in the population’s blood pressure and cholesterol levels.
The research looked at how changes to drug treatments and various preventative measures lead to the fall in death rates. It found that giving cholesterol-reducing statins to those who were at high risk of having another heart attack or stroke, saved 5,300 lives.
The latest news on statins
Women and heart attacks
The figures seem to indicate that when it comes to heart attacks, men have a worse time of it. Around 110,000 men and 65,000 women in the UK are diagnosed as having had a heart attack each year. However, in recent years the facts behind the figures have been questioned. Are women really less prone to heart attacks, or are they harder to spot?
My health story: I had a heart attack
New research, from a study published in the BMJ and funded by the British Heart Foundation, suggests that women are being under-diagnosed. Although women are nearly three times as likely to die from a heart attack as they are from breast cancer, it appears that their heart attacks aren’t always spotted.
The subtle signs of a woman's heart attack
The researchers carried out the study on over 1,000 men and women admitted to the Royal Infirmary of Edinburgh hospital with chest pain. They compared the results from the current blood test used worldwide to check for heart attacks, with a new, more sensitive test. The blood test checks for a protein called troponin, which the heart releases during a heart attack.
The research found that when using the new test they diagnosed double the number of heart attacks in women, bringing them in line with men. More research is being carried out, and if this confirms the results of the first study, it could mean a big step forward for women’s heart health.
Women's heart attacks and misdiagnosis
Age is another important factor for women and heart disease. Before women reach the menopause, they may have some protection from CHD because of their hormones, and so their risk of heart attack may be lower than men’s. However, during and post-menopause (often around the age of 50), women’s hormones change, and by the time women reach their 60s, their risk of having a heart attack rises to be almost the same as it is for men.
That means women as well as men need to look at heart disease risk factors and give up smoking, watch their alcohol intake and diet, watch their weight, and exercise regularly.
Dr Mark Porter on angina
It is often said that we are only as old as our arteries, but how old are yours? Doctors tend to focus on changes in the coronaries supplying the heart, but their condition - or ‘age’ – is reflected elsewhere, including in the legs and genitals. So, what should we be looking for?
Chest pain or tightness on exertion (angina) is the cardinal symptom of ageing and narrowing of the coronaries. It is a sign that the heart muscle isn’t getting enough blood because flow isn’t what it should be – normally because of one or more pinch points in the system caused by ‘furring up’ (cholesterol-rich deposits, or plaques, in the walls).
However, sometimes it is narrowing in the arteries supplying the legs that appears first – basically ‘angina’ of the calf muscles brought on by the same exertion, and for the same reason. Known as intermittent claudication (after the limping Roman emperor Claudius), it is relieved by rest and, like angina, tends to be worse on inclines and in cold weather. Don’t ignore it.
Another, more subtle, clue in men may be difficulty getting or maintaining an erection (erectile dysfunction). Although there are other causes of ED, most are due to ageing of the circulation supplying the penis and it is often the first clue to arterial problems that can lead to an early heart attack or stroke. It may be affecting your penis now, but your heart could be next.
Extract taken from Dr Mark Porter's column in Saga Magazine, November 2018. For more travel tips, subscribe to the magazine today!