GENDER AND HEART DISEASE:Angina Pectoris, The Risk factors in CHD

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Gender Issues In Psychology (PSY - 512)

Lesson 36

GENDER AND HEART DISEASE

Recap:

In the last few lectures we have been talking about issues pertaining to Gender and Health. We have discussed

the issue of longevity, social, cultural factors influencing health status, and uptake of available medical facilities.

Besides, we have also looked into the relationship between exercise and health. We also talked about the very

concept of "health" and being healthy.

Health, as defined and accepted internationally, is a state of complete physical, psychological/mental, and social

well-being, rather than mere absences of disease. The emphasis of health psychology and other health related

disciplines today is on health enhancement and disease prevention. The main objective behind this emphasis is

at least twofold:

b) To improve quality of life, and in turn longevity, and

c) To reduce cost of healthcare

But interest and research in this area can not be restricted to these two areas alone. We know that many people,

even when following perfectly healthy life styles, may develop serious illnesses. These illnesses or diseases

develop as a result of variables, or risk factors, over which people have very little control. In the next few

lectures we will be focusing upon health problems that can have serious consequences, and can be life

threatening. We will be discussing some of the major killers of today. Although we will be talking about these

diseases in general too, our main emphasis will be upon the risk factors for females, as well as how these

diseases may affect a females' physical, mental, and social well-being.

In the forthcoming lectures, we will be discussing:

· Gender and Heart Disease

· Gender and Cancer

· Eating Disorders

· HIV/AIDS

· Problems of females' reproductive health

· Gender and mental illness

Some of these disorders are specific to women, or found more commonly in women. Whereas some occur in

both men and women, but little attention is paid to the risk for women. In our discussion of these problems we

will primarily focus upon data about females, and will discuss the general nature of the disease very little,

assuming that this has been covered in health psychology.

Heart Disease

When we talk about heart disease in the present context, we are primarily referring to Coronary Heart Disease

or CHD. CHD refers to problems, or diseases, affecting the circulatory system and hence the blood supply to

various parts of our body including our heart. The main or root cause of CHD is atherosclerosis.

Atherosclerosis refers to the thickening of the coronary arteries. Coronary arteries are the vessels, or the

pipelines, that supply blood to the heart. Build up of plaques is the primary cause of this condition. When the

blood vessels are thickened, they are less flexible, hardened narrowed and less capable of sustaining fluctuations

in the pressure with which blood passes through these vessels. In common, everyday, vocabulary

atherosclerosis may lead to a variety of problems:

· Difficulty in blood flow

· Blockade in blood flow

· Restricted blood flow and restricted blood supply to the heart and other organs, muscles and tissues

· A lack or poor supply of oxygen to various organs and muscles

· A resulting pain especially in the chest region

· A resulting difficulty in breathing

Gender Issues In Psychology (PSY - 512)

What happens to the body when the blood vessels are not in a good shape???

In any living organism, if every thing goes wrong with even the tiniest part of the body, it affects the whole

system. Similarly when the basic infra structure of the circulatory system is affected; it affects the whole system

very seriously. The impact of problems in the circulatory system is serious because this system has a direct,

continuous, non stop contact with the whole body. Arteries carry oxygen and nourishment to the heart. As a

result of atherosclerosis the supply of these essential substances to the heart is restricted; it may be obstructed

partially, and at times completely. This state of affairs may result into two different but related conditions:

· Angina Pectoris

· Myocardial Infarction (MI) or Heart attack

Angina Pectoris

It refers to the restricted blood supply to the myocardium, or the heart muscle. This temporary and usually

short term, restriction or shortage of oxygen and nourishment results into the `alarm' of heart disease, i.e.,

angina. This usually results into pain, mostly crushing pain. The pain is frequently experienced in the chest and

arm region. However the pain may be experienced in other parts of the body as well. It is accompanied by

breathing difficulty, and a feeling of suffocation. Symptoms of Angina are usually experienced after heightened

stress or exercise, because the demand of the heart for oxygen and energy increases. These symptoms usually

last for a few minutes and they are a warning that the heart needs to be taken care of.

Myocardial Infarction (MI)

MI is the serious form of CHD. When, as a result of obstructed blood supply, or blocked coronary arteries,

oxygen supply to the myocardium is shut off, it damages the heart muscle. Like any other tissue or muscle, the

heart muscle can not survive without oxygen. As a result the affected part or tissue of the myocardium dies in

the absence of oxygen. The death of a part of myocardium is called an infarction; hence myocardial infarction

or heart attacked. This damage to the heart muscle is permanent. The symptoms of an MI may include:

· Severe crushing or squeezing pain in the chest, arms, shoulders, back, abdomen or jaws.

· Weakness, dizziness, and/ or nausea.

· A feeling of severe suffocation, or difficulty in breathing.

The Risk factors in CHD

· Some risk factors in CHD that is inherent and fixed, over which one has no control e.g. family history,

diabetes, congenital defects or gender; men being at a higher risk.

· The physiological conditions that may be associated with CHD including hypertension, obesity, and

high serum cholesterol.

· A number of CHD risk factors are lifestyle related e.g., smoking, high cholesterol diet, sedentary

lifestyle, and a stressful routine.

· Type A personality pattern has been known to have a positive correlation with CHD.

Gender and Coronary Heart Disease

Heart disease is the major killer in the modern world. Men, or women, both can develop CHD, at any stage of

life. However men have been found to be at higher risk of developing CHD. Most of the research findings

available on CHD focus primarily on men. Most of the data available on CHD in women has been yielded by

studies involving mixed subjects. Very few studies are available that have investigated heart disease specifically

in women.

Most of the broad based data available has been taken from American samples. Men and women of all age

groups may develop CHD, but more men than women die of CHD. It has been found out that in the U.S.,

men at all age levels are at a higher risk of dying of cardiovascular disease (CVD). The difference between men

and women for death by CVD is the greatest in the middle age years. In people aged 35-74 years, men have an

almost double rate of death by CVD. Yet the rate of female deaths by CVD becomes pretty high in age groups

75-85 (Brannon, and Fiest, 2000).

Gender or sex of a person has been found to be one of the significant risk factors in heart disease.

Gender Issues In Psychology (PSY - 512)

The famous, and widely quoted, Framingham, Massachusetts, research project identified a number of risk

factors for CHD (Sytkowski, Kannel, and D'Agostino, 1990) . These risk factors include:

Male sex

Advancing age

Cigarette smoking

Hypertension

Diabetes

Obesity

Gender and Heart Disease: Some Facts

· Research shows that although the rate of death by heart disease in men is almost the double of

women's rate, men have a significantly better prognosis than women.

· If men survive the first serious heart attack, then they are more likely to have a favorable

diagnosis (Wenger, 1982).

· In case of diabetic people, the risk of CHD is almost the same in both men and women.

The Framingham Heart Study

The Framingham Study is one of the most authentic and broad spectrum investigations into heart disease. The

study was initiated in 1948 (Brannon, and Fiest, 2000). Initially more than 5000 residents of Framingham,

Massachusetts, USA were included as the sample, all free of heart disease at that time.

This prospective epidemiological study aimed to follow the sample for 20 years to study heart disease and

related factors. Later on, considering the valuable information yielded by the study, the time period was

extended and it continued for more than half a century. In 1971, 5000 children of the sampled subjects and

their spouses were included in the sample. After about another 20 years a third generation was also included

(Voelker, 1998). Therefore one can see that the risk factors, including sex, identified by the study are genuine

risk factors.

Type a personality pattern is a significant risk factor in CHD, but there is no conclusive evidence

available as to a lower rate of Type A behavior in females.

Coming back to the facts about CHD, we now know that:

a) Men are at a higher risk

b) Following an MI, the chances of survival of men are higher

c) The Framingham Study has revealed that women will be particularly prone to developing heart disease

if they are: diabetic, overweight/obese and having a high level of LDL Cholesterol.

LDL refers to low density Lipoprotein i.e., the harmful or `bad' cholesterol. Coronary heart disease is the major

killer of women too; when the overall rates are considered, more women than men die of heart disease.

What causes natural protection of women against heart disease?

There is significant evidence available, suggesting that young females are naturally protected against heart

disease, and this causes a very low rate of females dying prematurely of heart problems. The same factors are

one of the possible causes of lower life expectancy of men.

However, the protection of women against heart disease is restricted to young and middle aged women. These

possible causes include the following;

1. Estrogen Levels:

The female hormone estrogen has the quality of diminishing the arousal of sympathetic nervous system, thus

having a protective effect (Matthews, and Rodin, 1992).

2. Women tend to have higher levels of HDL or high-density lipoproteins. The high levels of estrogen in pre-

menopausal women have been found to be related to high estrogen levels.

3. The HDL has a suppressing effect on the LDL, which is considered to have a harmful effect, and to be

contributory factors in heart disease.

Therefore the higher HDL levels provide a protection against heart disease in women (Matthews, and Rodin,

1992). Pre-menopausal women, known to have high levels of HDL, as well as estrogen as compared to men,

Gender Issues In Psychology (PSY - 512)

exhibit smaller increases in blood pressure, neuro-endocrine, and some metabolic reactions, in response to

stress (K.A. Mathews, 1989; K.A. Mathews, Davis, Stoney, Owens, and Caggiula, 1991).

All these protective factors operate in pre-menopausal women, and the risk of developing heart disease in post

menopausal women is about the same as in men. However the risk-age, for heart disease in women is around

15 years later than in men.

When are women at a higher risk of developing heart disease?

Women risk of developing heart disease rises in the post menopausal phase. In this period some direct and

some indirect causes lead to heart disease, MI and/or death due to CHD:

Firstly, the estrogen levels decrease, or diminish removing the natural protection.

Women tend to gain weight during menopause that leads to various risk factors i.e., increased blood

pressure, cholesterol and triglycerides (Wing, Matthews, Kuller, Meilahn, and Plantinga, 1991).

Which women have a lower risk of CHD?

Women with the following characteristics are at a lower risk of developing CHD:

Pre-menopausal women

ii.

Women of normal/ideal weight

iii.

Physically active women

iv.

Women indulging into regular strenuous exercise

Women with lower cholesterol and triglyceride levels

Why are men at a higher risk?

Research has revealed a number of variables that cause a higher risk of heart disease in men:

Testosterone:

The male hormone testosterone, found in high amounts in men, has been found to be linked with

competitiveness and aggression.

These behaviors are associated with stress, Type A behavior.

In turn testosterone has been found to be linked with CHD.

ii.

Unhealthy/Risky Lifestyles:

More men than women indulge into risky behaviors e.g. smoking, alcohol use and eating high-fat foods.

These behaviors lead to conditions that may lead to developing CHD.

When men and woman indulge into similar risky behaviors, the likelihood of dying of CHD is higher for men

than women (Fried et. al., 1998).

iii.

High Stress occupations:

More men than women are involved in high stress jobs and stress is a causal in CHD.

Preventing and Managing Heart Disease

Research shows that modifying life styles, altering or quitting unhealthy behaviors, and adopting healthy life

styles can help prevent and manage CHD.

The following behaviors are therefore recommended for both men and women.

Regular exercise

Healthy eating; avoiding LDL, reducing cholesterol

No smoking

Weight maintenance

Estrogen replacement therapy in females has been found to be practically

Helpful

The Status of Research on Heart Disease in Women

There is a general dearth of investigations specifically aiming to explore heart disease in women. There are a

number of probable reasons for this tendency on part of medical, or health-oriented, researchers:

a) It is mostly men who die early due to cardiovascular disease (CVD), and very few women die

prematurely of CVD.

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Gender Issues In Psychology (PSY - 512)

b) Heart disease is generally considered a men's disease; young or pre-menopausal women appear to have

a natural protection against heart disease.

In older, menopausal, women, the risk is not hugely different from that for men. The data available on the

prevalence of heart disease in women and risk factors involved have primarily been obtained from studies on

general population.

`Sexism' and Male-dominance in Research on Heart Disease

Some health researchers are of the view that `sexism' is the cause of the dearth of research into heart disease

and related factors in women. Such researchers maintain that sexism, or positive bias towards men, operates in

the allocation of funds, and research on men versus women (Altman, 1991). Besides, they believe, a concern

over "male" problems is muchgreater than the concern over female problems; this is another factor causing

dearth of research evidence available on women and heart disease.

As a result of this intentional or unintentional, positive bias towards men, heart disease in men gets greater

attention.

Consequently heart disease gets diagnosed earlier in men, as more awareness and sensitization prevails in this

direction. On the other hand there is very little evidence available on:

a) The risk factors for heart disease in females

b) Whether or not men and women have the same risk factors

The Changing Trends

In the recent past, especially after a growing interest in gender issues, a shift in the trend has been taking place.

Although not yet significantly large in number, more research than before is being carried out for exploring

heart disease in females. The increased rate of heart disease in females has also been a precipitating factor for

the growing interest in research in this area.

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