​Holiday heart attack: the dark side of Christmas (that may be worse for women)

By Ellie Liverani

eli.liverani.ra@gmail.com

At the beginning of the movie “How the Grinch Stole Christmas," the Grinch is introduced as having a smaller than average heart, but as the movie progresses, his heart increases three times its size. In the story, this means that the Grinch became a kinder and more compassionate creature. But in real life, a swollen heart can have different meanings and implications, including risk of heart diseases.

Indeed, the statistic tells us that the risk of heart attacks increases during the holiday season.

We have always thought that the incidence of heart attack was higher in men than in women. Women's risk of heart disease was comparable to men’s only after menopause (or in general when estrogen levels diminish).

However, as of today, heart disease is a leading cause of death in women in the U.S., and North Dakota is no exception. Age still plays a role; women seem to still suffer from cardiovascular diseases after menopause and at an older age than men. The outcome is worse for women, with higher mortality and higher chances of having another heart attack within five years.

But age is not the only factor, because today cardiovascular diseases are the leading cause of death in women of all ages. Did something change in women’s health? Or did we reach the wrong conclusions in the past?

First, we have discovered that women have different symptoms from men. Chest pain is the most common symptom in men, but not in women. Indeed, pain in women can be located in different parts of the body, such as the neck, back and jaw. Nausea and digestive issues can be experienced. Extreme fatigue and shortness of breath are common, too.

Heart diseases in women may have been under-reported and/or mistaken for other diseases

Every heart attack is different. The symptoms can be severe, or they can go unnoticed. Considering the variety of symptoms in women, the symptoms are often blamed on stress or a stomach bug. This can delay when women seek help. As we know, early intervention is crucial for the outcome.

Because it was thought very unlikely for a young woman (30-50 years old) to have a heart attack, women have not always received the proper care or even prevention. Underlying diseases such as diabetes, high cholesterol, or high blood pressure can also go untreated in women.

Drugs taken by women, like the contraceptive pill or hormonal replacement therapy, can increase the risk of heart attacks — and so does pregnancy. This could explain why younger women may have a higher risk than in the past. Certain diseases, such as autoimmune disorders and Alzheimer’s that have a higher incidence in women are also associated with increased risk of cardiovascular diseases.

In the end, we do not know whether heart attacks in women are on the rise or whether they were under-reported. Still, awareness is key.

The good news is that heart diseases are preventable with changes in lifestyle. No magic pill is available, just the traditional recommendations: quit smoking, exercise regularly, eat healthy food and maintain a healthy weight.

The recommendations are relatively simple, but not always achievable for most women. If you have a large family and a job (or sometimes two) this is hard. Women are also caretakers of the elderly, so if you add an aging parent to the list, then it is even more overwhelming.

Heart attacks are common in young women, but other symptoms like fatigue or digestive issues can mask them. Let’s be aware that during the holidays, our lifestyle may change with excessive alcohol consumption, richer food, or increased stress from travel, family and work. That can impact our heart health, like the Grinch. As a result, we may become kinder and more compassionate. Or it can also damage our bodies. Or both.

Dr. Liverani is an assistant professor at the NDSU School of Pharmacy.