HEART MATTERS
WOMEN'S RISK OF CARDIOVASCULAR DISEASE (CVD)
CVD is the #1 cause of death in women worldwide. In 2019, cardiovascular disease accounted for 27.4% of women's death in Singapore, meaning almost 1 out of 3 female deaths is due to heart disease or stroke.
CVD is caused by disorders of the heart and blood vessels. It can affect anyone at any age, and it is not just a man's disease. Risk factors of CVD can be modifiable or non-modifiable.
Modifiable Risk Factors include:
Smoking
High Blood Cholesterol
High Blood Pressure
Diabetes
Physical Inactivity
Overweight/Obese
Stress
Non-Modifiable Risk Factors include:
Age
Gender
Ethnicity
Family History
MODIFIABLE RISK FACTORS INCLUDE:
SMOKING
Smoking is a major cardiovascular risk factor because of the harmful effects of tobacco. The carbon monoxide in cigarette smoke can damage the inner lining of blood vessels and reduce the oxygen level in the blood. This irritates the blood vessel walls and may trigger the onset of atherosclerosis (build-up of plaque in arteries).

In general, women who smoke are at a higher risk of heart attack as compared to men who smoke. A woman who smokes 3 to 5 cigarettes a day faces a doubled risk of heart attack, whereas a man would have to smoke 6 to 9 cigarettes a day to double his risk.

Passive smokers (people who do not smoke but are regularly exposed to smoke by others) face the same health risk as smokers – approximately twice the risk of heart attack and are more than twice as likely to meet with sudden cardiac death.

Although smoking causes a great deal of damage, quitting smoking can effectively reduce her cardiovascular risk close to that of a person who has never smoked. It is never too late to take the first step to quit smoking and take charge of your heart health.
HIGH BLOOD CHOLESTEROL
There are two main types of cholesterol: low-density lipoprotein (LDL) or bad cholesterol and high-density lipoprotein (HDL) or good cholesterol. LDL cholesterol carries fat from your liver to other parts of the body – the higher the LDL level in your blood, the greater your risk of developing atherosclerosis (plaque build-up in arteries).

High levels of triglyceride (a common type of fat found in the body) combined with high levels of LDL cholesterol can speed up atherosclerosis, increasing the risk of heart attack and stroke.

Although premenopausal women have a lower risk of CVD as the female hormone Oestrogen helps to raise HDL cholesterol levels and protects them against heart disease, it is still vital to keep your cholesterol levels in the healthy levels as seen in the table below:
Cholesterol Healthy Cholestrol Level in mmol/L (mg/dL)
Total Cholesterol <3.4 (130)
LDL Cholesterol 1.0 – 1.5 (40 – 59)
HDL Cholesterol <2.3 (200)
Triglycerides <5.2 (200)
Protect yourself against CVD by keeping your bad cholesterol low and good cholesterol high. You can combine a low-fat diet with exercise and weight control to attain healthy cholesterol levels.
HIGH BLOOD PRESSURE
When a woman's blood pressure is consistently at or greater than 140/90mmHg, she has high blood pressure or hypertension.

Hypertension occurs when the blood vessels narrow, forcing the heart to pump harder and blood to exert higher pressure against the vessel walls to push its way through.

Over time, the force and friction of high blood pressure damage the delicate tissues inside the arteries. In turn, LDL (bad) cholesterol forms plaque along tiny tears in the artery walls, signifying the start of atherosclerosis. Injury to blood vessels in the kidneys, brain, and eyes also may occur, leading to kidney failure, stroke, or vision loss.

Majority of hypertensive patients are diagnosed with primary hypertension, which is caused by a combination of hereditary and lifestyle-related factors such as excessive salt intake, obesity and stress. Only about 5% of hypertensive patients are diagnosed with secondary hypertension – where the elevated blood pressure is attributed to specific condition or illness, such as kidney disease or a structural abnormality of the aorta.

You can lower both primary and secondary hypertension through medication and control measures, such as weight reduction, regular exercise and salt reduction.
DIABETES
Image credit: Healthline.com
Diabetes is a long-term illness characterised by a high sugar (or glucose) level in the blood. There are two main types of diabetes – type 1 and type 2.

Type 1 diabetes is a condition where the body produces no insulin at all. It usually arises during childhood and is managed by administering regular insulin injections to the patient throughout his/her life.

Type 2 diabetes occurs when the body is unable to use insulin effectively. It usually develops in adults and is managed with oral medications with or without insulin injections.

According to the American Heart Association, adults with diabetes are 2 to 4 times more likely to die from heart disease than adults without diabetes. But the good news is: you can control diabetes with measures such as weight reduction, a strict diet and regular exercise.
PHYSICAL INACTIVITY
Exercise helps boost HDL (good) cholesterol and reduce LDL (bad) cholesterol in the blood. It also assists in weight control and promotes cardiovascular fitness.

A lack of exercise may double a person's risk of developing CVD. This is because a physically inactive person is more likely to become overweight and/or have high blood pressure, diabetes, and high LDL cholesterol, which adversely affects one's heart health.

It is recommended to have at least 150 mins of moderate to vigorous intensity physical activity per week. Regular exercise can help maintain a healthy Body Mass Index (BMI) and manage high blood pressure and diabetes, which reduces the risk of CVD.
OVERWEIGHT/OBESITY
For a person whose body weight exceeds the recommended weight range by 20% or more, the risk of heart attack is about three times greater than a person who is within the healthy weight range. Being overweight and obese raises the likelihood of developing hypertension, diabetes, and atherosclerosis, which are CVD risk factors.

A way to know if a person is overweight or obese is by calculating their Body Mass Index (BMI). A healthy BMI should fall within the range of 18.5 – 22.9kg/m2.

You can calculate your BMI using the formula below or our online BMI calculator:
STRESS
Image credit: Health Hub
Stress is the state of psychological tension caused by physical, emotional, socio-economic or mental pressure. It is a normal human response that serves as a built-in warning mechanism to restrain us from pushing ourselves beyond our subjective limits.

While moderate stress may sometimes be beneficial as it pushes you to work harder and improves your performance, excessive stress can be harmful to your health. People under stress may develop bad habits such as smoking or overeating, which puts them at risk of developing CVD.

If you ever feel too stressed, take a break, do activities such as exercising or playing a game with your friends. It is also important to stay positive, believe in yourself and learn from mistakes. Manage your anger by taking deep breaths and resolve the problem calmly.
NON-MODIFIABLE RISK FACTORS INCLUDE:
AGE
A person's risk of developing CVD increases with age due to changes in the heart and blood vessels. This includes the increased stiffness of large arteries, and the buildup of fatty deposits in the walls of arteries over many years, resulting in high blood pressure and high cholesterol, which are risk factors of heart disease.

There may also be changes in the rate or rhythm of the heart as one ages.

On average, 80% of those who die of coronary heart disease are 65 years old and above.
GENDER
Image credit: Healthline.com
Although men face a higher risk of heart disease, women are just as likely to have heart attacks as their male counterparts of similar age after they reach menopause. This is due to the drop in Oestrogen, a female hormone which reduces LDL (bad) cholesterol and raises HDL (good) cholesterol. With the decline in Oestrogen, a women's LDL level and blood pressure will increase while HDL cholesterol decreases, putting women at a higher risk of developing CVD.

Women who consume oral contraceptives also face a slightly higher risk of CVD, as their blood lipid levels may be detrimentally affected by the hormones in these pills. If the woman taking oral contraceptives is also a smoker, her risk of CVD is even higher after 35 years old.

Pregnant women also face a greater likelihood of developing palpitations, hypertension and congestive heart failure. This is because a woman's blood volume increases 30% to 50% during pregnancy to nourish the growing baby; as such, the heart has to pump more blood each minute and heart rate increases. Although pregnancy-related palpitations are rarely dangerous, hypertension and congestive heart failure require close monitoring as these conditions are potentially more severe.
ETHNICITY
The risk for coronary heart disease varies with different ethnic groups. Based on the National Population Health Survey 2019, diabetes was most prevalent among Indians than the Chinese and Malays, while Malays had the highest prevalence of hypertension, high cholesterol, and obesity.
FAMILY HISTORY
Image credit: Healthline.com
A family history of stroke or heart disease is a strong risk factor for cardiovascular illness, as some of the contributory factors such as diabetes, high blood pressure and high LDL (bad) cholesterol may be inherited.

In addition, people often behave and act as their parents or siblings do, such as adopting a sedentary lifestyle, picking up smoking, becoming overweight/obese, or following poor diets.