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Heart attacks only affect super-stressed, middle-aged men, right? Wrong. Coronary heart disease is the single biggest cause of death among women, killing 30,500 women in Britain each year - three times as many as breast cancer.While smoking and fatty diets are well-known risk factors, there are other, less obvious ones. So, what are the chances of having a heart attack if you are a woman?
What are the risk factors for having a heart attack if you are a woman?
To find out, we quizzed a group of women about their health, family history and lifestyle and then asked Dr Glyn Thomas, consultant cardiologist at the Bristol Heart Institute, to assess their risk - and for advice on how all women can protect themselves.
WINE EVERY NIGHT
At risk: The main concern for Michelle is that her mother had a heart attack, although she's not helping matters by drinking so much wine
Michelle Brown, 46, a marketing consultant, is single and lives in Yorkshire. She is 5ft 5in and weighs 11st (Body Mass Index - or BMI - of 26.6, which means she's overweight). She says:
A few years ago I thought I was having a heart attack: I had gripping chest pains that would come and go and I felt breathless.
I was terrified, especially as my mother had a heart attack when she was 40, even though she was in good health.
My blood pressure and cholesterol readings were normal so my doctor concluded I was suffering from stress. It made sense as at the time I was having a lot of difficulties with a colleague and had terrible insomnia. I took redundancy a short time later and am now self-employed, which has removed all that worry.
However, I'd like to lose a few pounds. I exercise only once a week, walking the dog. I do like a drink - I have two glasses of wine a night and maybe a bottle at the weekend - adding up to 25 units a week.
EXPERT COMMENT: Michelle's BMI is above normal and she's not helping her weight by drinking all that wine, at 250 calories a glass.
Putting weight on her hips and middle puts Michelle at risk of raised blood sugar levels and diabetes, which can trigger high blood pressure and cholesterol - risk factors for heart disease.
One to two glasses of alcohol can be heart protective, but only after the menopause, though it's not clear why. Aside from weight gain, excess alcohol can cause abnormal heart rhythms and damage to the heart muscle.
Being single also has an effect on risk: a study in the Journal of Preventive Cardiology found single women were 60 to 65 per cent more likely to have a heart attack than married women, maybe because married people are better off financially or have more social support so tend to be less stressed.
But the main risk for Michelle is that her mother had a heart attack. One Swedish study found that women whose mothers had heart disease were at a 43 per cent greater risk of the same problem. Her mother was also young, so it's less likely to have been linked to lifestyle.
Having a mother, brother or sister who developed cardiovascular disease at a young age (under 65 for women and under 55 for men) also increases risk.
HEART ATTACK RISK: ONE IN TEN
HRT FOR EIGHT YEARS
Beneficial: The fact that Sharon took HRT for eight years may in fact have a protective effect
Sharon Ferster, 55, a model and TV host, lives in Hale, Cheshire, with husband Warren, 63, a managing director. The couple have two adult daughters and one granddaughter. Sharon is 5ft 6in and weighs 10st (BMI 22.6 - normal). She says:
I've always looked after myself as I need to look good for my job. I've never smoked, eat a low-fat diet and don't drink more than a couple of glasses of wine a week. I also work out with a personal trainer a couple of times a week.
But a couple of years ago I started suffering bloating and feeling nauseous, tired and cold all the time.
My GP diagnosed an underactive thyroid, which meant my body wasn't producing enough of the thyroid hormone, slowing down my metabolism. I was prescribed thyroxine and feel fine now. My only other health concern has been high cholesterol, diagnosed 20 years ago during a routine check.
It was quite high at 7.9 (a healthy reading is five). I've been taking statins but my last reading was still 7.6. The doctors have changed my medication to try to keep it down because at one point it leapt up to nine. I had to have a hysterectomy at 39 because of ovarian cysts and went through the menopause. I had hormone replacement implants for eight years to treat the symptoms.
EXPERT COMMENT: An underactive thyroid, which affects 15 in every 1,000 women, can be an issue for heart health. That's because it can raise blood pressure - a third of women with an underactive thyroid will have a high reading (anything over 140/90).
Sharon's readings are normal, but she should still have yearly checks.
Despite her healthy lifestyle, her cholesterol is much too high and this is what puts her most at risk - she must see her specialist immediately about increasing her statin dose as what she's taking clearly isn't working. She should have her cholesterol checked at least once a year. Otherwise her arteries could fur up and trigger a heart attack.
Post-menopausal women are at higher risk of heart problems because of dropping levels of oestrogen, which is cardio-protective (possibly because it helps stop blood cells sticking to artery walls and forming blockages).
However, if a woman takes HRT for a decade after starting the menopause, her risk returns to what it was before the menopause. So the fact Sharon took HRT for eight years may have a protective effect.
HEART ATTACK RISK: ONE IN 20
HAS A SWEET TOOTH
Cause for concern: Bernette has a lot to be worried about - her sweet tooth, her family history, her polycystic ovary syndrome
Bernette Clarke, 49, a hospital waiting list co-ordinator, lives in Bury, Lancashire, with her husband, Michael, 55, a businessman. They have three grown-up children and four grandchildren. She is 5ft 5in and weighs 12st 4lb (BMI 28.6 - overweight).
I've struggled with my weight since I was a teenager. I've tried diets, slimming clubs, acupuncture and hypnosis. I have an incredibly sweet tooth and no willpower. I don't smoke and am teetotal, but find chocolate, sweets and cake irresistible. In desperation I had a gastric band fitted eight years ago and my weight dropped from 17st to 12st over a year. I'd love to lose another two stone.
But even though the band forces me to eat small portions of soft food, I still eat sweets and chocolate.
I also have polycystic ovary syndrome, which causes hormonal imbalances and may have affected my weight.
I do worry about my heart - my father died of a heart attack at 54. His father also suffered a fatal heart attack, at the even younger age of 49.
I found out I had high blood pressure ten years ago through a routine medical check. It was 170/113, which is catastrophic. I was immediately put on medication and also take statins for high cholesterol. I don't do any exercise other than a 15-minute walk, twice a day, to and from the car park into work.
EXPERT COMMENT: Bernette has an awful lot to be worried about. Despite her impressive weight loss, her BMI is still too high. Cakes and biscuits are high calorie and laden with saturated fat. The average woman should eat no more than 20g of saturated fat a day.
She also has a strong family history of premature coronary disease, which, taken with her high blood pressure and cholesterol, puts her at higher risk of heart disease. What's more, she has suffered with polycystic ovary syndrome, a hormonal disorder affecting 10 per cent of women of reproductive age.
The risk of heart attack is four to seven times higher in these women, though the reason why is unclear. Bernette needs to embark on a low-fat diet of protein, fruit and vegetables and exercise more in order to shed that excess weight and improve her cardiovascular health.
HEART ATTACK RISK: ONE IN THREE
HIGH BLOOD PRESSURE
On safe ground: Louise's healthy lifestyle and BMI suggest her high blood pressure is genetic. Provided this is controlled with medication, it shouldn't prove a problem
Louise Stewart-Muir, 49, a company director, lives in Surrey with her husband Greg, 49, a businessman, and their three children. Louise is 5ft 4in and weighs 9st (BMI 21.6 - normal). She says:
I developed high blood pressure during each of my pregnancies because of pre-eclampsia. This settled after each baby was born, but, several years ago, I was diagnosed with high blood pressure.
I was stressed at the time, juggling home, work and visiting my ailing parents three times a week. It has remained high since then (it's 140/80) and I take medication to control it. My sister also has high blood pressure.
About a year ago, I developed atrial fibrillation - an abnormal heart rhythm - which gives me palpitations. But my lifestyle is healthy; I do pilates and spin classes three times a week; I drink only a few glasses of wine at weekends; and do a two-day fasting diet. I hope it's enough.
EXPERT COMMENT: Pre-eclampsia is a serious condition that affects one in ten pregnancies and causes abnormally high blood pressure in the second half of pregnancy. This is a worry, as it can carry a higher risk of cardiovascular disease in later life.
The Institute for Women's Health at University College London Hospitals found women who developed pre-eclampsia were at more than double the risk of heart disease, including fatal heart attacks. Their risk of stroke and blood clots was almost as high. One possible reason is vascular damage caused by the pre-eclampsia.
Given Louise's healthy lifestyle and BMI, the high blood pressure is likely to be genetic, especially since her sister also has it. Provided this is controlled with medication, it shouldn't cause any problems. But she is wrong to be dismissive of atrial fibrillation, which causes the top chambers of the heart to quiver. This can significantly raise the risk of stroke. She should be taking a blood-thinning medication such as warfarin.
HEART ATTACK RISK: ONE IN 25
USED TO SMOKE
Youth is on her side: But Clare needs to make significant lifestyle changes immediately
Clare Skinner, 31, an admin assistant, is single and lives in Co. Durham. She is 5ft 3in and weighs 10st (BMI 24.8 - normal). She says:
I'm terrified of having a heart attack because my mum had one right before my eyes on Christmas Day four years ago at just 49.
We rushed her to A&E where she was diagnosed with a blocked heart valve. Looking back, the warning signs were there as she'd had chest pains on and off for five years - though her GP put this down to anxiety. She also smoked 20 cigarettes a day, although she's stopped now.
I used to smoke too, about 15 cigarettes a week, until I gave up around eight years ago.
My problem is I have a sedentary job - I'm either in front of a computer or driving to and from work. At best I walk my two dogs for 20 minutes when I can. I'm addicted to carbohydrates - I love bread, pasta and other stodgy food.
I only drink the odd glass of wine, have swapped full-fat for low-fat products, and I cook fresh meals rather than eating junk food.
What happened to mum was a real wake-up call.
EXPERT COMMENT: Clare's mother's heart attack was probably smoking-related and so by quitting, Clare has by now reduced her own risk to that of a life-long non-smoker - the risk reduces quite rapidly after stopping (women smokers have a 25 per cent higher risk of heart disease than men because their bodies are more affected by the toxins).
She needs to cut down on eating fatty dairy foods and carbohydrates and eat lots of fresh fruit and vegetables. Despite having a sedentary job, 30 minutes of brisk daily dog-walking can be very beneficial, even if it is split into two sessions, so she needs to find time to do that most days. She also needs to get her cholesterol and blood pressure checked.
Clare is only 31 and has youth on her side, but she needs to make changes to her lifestyle immediately. Whatever her risk factor is now, this will double by the age of 60 unless she loses some weight and takes more exercise.
HEART ATTACK RISK: ONE IN 15
SNORES AT NIGHT
Low risk: Deborah is physically active which is a good sign, but she should talk to her GP about her snoring
Deborah Joseph, 52, a GP, lives in Manchester with her husband Howard, 52, a businessman and her three children from a previous marriage, aged between 18 and 23. At 5ft 2, she weighs 8st (BMI 20.4 - normal). She says:
As a GP I really understand the need to stay in shape.
I'm utterly addicted to exercise: I do something every day for about an hour at a time, whether a pilates class, yoga, swimming or spinning.
I've done various long-distance charity bike rides and also a triathlon.
I know it's more than the recommended average but I don't feel I'm doing too much because I feel so fit and healthy.
I'm teetotal, and my only weakness is chocolate.
Despite being slim, I seem to have an issue with snoring which has been going on for several months. I was tested for sleep apnoea - where you snore because you temporarily stop breathing - though this was negative.
EXPERT COMMENT: Deborah is slim and very physically active which is protective against heart disease.
However, too much endurance-type exercise can increase the risk of atrial fibrillation.
And she should watch her sweet tooth because of the high fat content in chocolate.
Her snoring is a concern, as this is linked to heart disease.
One study found that heavy snorers are six times more likely to suffer a heart attack while asleep because of blood pressure, nerve and hormonal changes caused by snoring.
So she should have it investigated further and talk to her GP because in the absence of sleep apnoea, or being a heavy drinker or smoker, there could be an underlying issue such as nasal polyps.
HEART ATTACK RISK: ONE IN 30
HAD MIGRAINES
Migraines: These can significantly increase the risk of heart attacks and stroke, although, thankfully for Rebecca, the risk drops away as migraines become less frequent
Rebecca Williams, 34, lives in St Albans with her husband Mark, 35, a vehicle technician, and their children Rubin, five, and Merlin, two. She is pregnant with their third child. At 5ft 4, her non-pregnancy weight is 10st. (BMI 24 - normal). She says:
In my early 20s I started suffering frequently with terrible migraines, and when I went to my GP about them I was diagnosed with high blood pressure. I was quite surprised because I was slim, fit and active.
However, my dad has suffered from high blood pressure for many years, so my doctor thought it could well be genetic.
I was initially prescribed medication, but I don't really like taking any drugs. So after a couple of months, my doctor agreed I could try to keep it down with exercise and good diet - occasionally reverting to medication if my blood pressure went up significantly. I also take garlic tablets.
For the most part it has been fine (I've had no more migraines), though during each pregnancy my blood pressure has been high. My last reading was 130/84 (the ideal blood pressure is 120/80). I was back on my medication for a week after Merlin was born, but have managed to stay off it since then.
EXPERT COMMENT: A recent landmark study found that women who suffer from severe migraines accompanied by visual disturbances may be at double the risk of heart attacks and stroke - possibly because migraine is caused by changes in blood flow, and heart attacks happen when the heart muscle is starved of blood.
However, that risk drops away as migraines become more infrequent.
Rebecca's blood pressure sounds as though it's genetic. It may be that exercise alone or in combination with alternative treatments will be sufficient to keep her blood pressure normal. But she should be aware that blood pressure which fluctuates between normal and high can be just as harmful as constantly high blood pressure.
I'd advise wearing a continuous blood pressure monitor for 24 hours to get a more accurate picture of her blood pressure.
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