Atypical presentation, low level of awareness, high threshold for corrective measures noted
BY MYLENE C.ORILLO
IN THE medical field, women were not initially included in researches on cardiovascular disease (CVD) thinking that what were true for men were also true for women.
But this is not the case. A recent New York Times article reported that heart disease in women is “the leading edge of a brewing storm.” It is the number one killer disease in women with atypical presentation, low level of awareness, and high threshold to act on it (both patients and doctors). This was stressed by Dr. Giselle G. Gervacio, the current training officer of the Philippine General Hospital, cardiovascular section, who talked about “Probing the prevalence of cardiovascular disease risk factors in women”.
According to Dr. Gervacio, there appears to be gender specific increase in the prevalence of obesity (android obesity), hypercholesterolemia, and lack of physical inactivity among women.
These factors are commonly found in the middle age except for physical inactivity which appeared to have a bimodal distribution.
In the 2013 National Nutrition Health Survey, which reviewed the following CVD risk factors–obesity, hypertension, diabetes, hypercholesterolemia, smoking, and alcohol consumption, it revealed that the overall prevalence of obesity among adults 20 years and over by age group and sex using the World Health Organization body mass index (BMI) classification is 8.3 percent, which is higher compared to male at 5.2 percent.
Compared to India, the Philippines is better off where the prevalence of obesity in India is 6.6 percent among males and 16.7 percent among females.
“It’s pretty high! But let us not pat ourselves on the back just yet because if we turn to android obesity (which is better predictor of cardiovascular risk), the prevalence is 23.1 percent among women and again the pattern follows that of obesity in general with a sharp increase as the individual reaches the third decade of life and progressively climbing up just as high as 32.0 percent by the sixth decade of life,” said Dr. Gervacio.
As to hypertension, Dr. Gervacio said the risk seems a little balanced. In fact, a little bit more among males and there is a gradual rise from the second decade upward in both males and females.
“So it’s roughly 19.9 percent among females and 25.1 among males,” she reported.
Compared to neighboring countries, it’s relatively higher compared to India where the prevalence among females is 22.4 percent and 13.4 percent among males; but lower compared to the indigenous people in Brazil where the prevalence is 53.2 percent in males and 40.7 percent among females.
“But then again we have to take into account the indigenous people in Brazil are on the heavy side,” said Dr. Gervacio.
Prevalence of diabetes
Diabetes, on the other hand, like hypertension, is distributed equally among males and females. The prevalence of diabetes among adults 20 years and over in the Philippines is 5.8 percent among males and 5.3 percent among females.
“The sharp increase happens in the fourth and fifth decade of life with the progressive doubling of risk between the second, third, fourth, to the fifth decade of life that peaks to the sixth decade of life,” said Dr. Gervacio.
Compared to India, they have doubled the risk of diabetes with 16.6 percent prevalence among males and 12.7 percent among women.
For hypercholesterolemia, the tables have turned once against females with higher prevalence of 51.4 percent compared to 41.5 percent among males of the general population in the Philippines, with a cut-off value of 200 mg/dl.
“The risk rise maybe between the second to the third decade where it’s a high as 40 to 50 and even 70 percent by the fifth decade of life. This is definitely higher than Indian, at 48.27 percent in males and 31.4 percent in females,” explained Dr. Gervacio.
Is hypercholesterolemia a result of high LDL? Dr. Gervacio said no because the LDL levels track the trend of total cholesterol which means that the hypercholesterolemia is mainly accounted for by bad cholesterol.
“You will see that the prevalence of high LDL defined as a cut-off of LDL of at least a 130 mg /dl is as high as 46 percent by the third decade of life. To make things worse, it appears that Filipinos have bad genes as far as low HDL.”
The prevalence of low HDL among women, 78.2 percent of the total women population has low HDL defined as an HDL of less than 50 mg/dl.
Vices and depression
When it comes to vices, only 7.8 percent of Filipina currently smoke as compared to 44.7 percent of males, but higher compared to India with only 0.1 percent of women who smoke.
“Looking at the age distribution among women, it appears that the younger people are tending to shy away from smoking more compared to the older population with 60-70 age brackets,” noted Dr. Gervacio. When it comes to alcohol consumption, 28 percent of women currently take alcohol and this is higher in the lower age bracket of 20s, 30s, 40s and less among the older individuals.
“It would appear that the older women smoke more, but the younger women drink more,” she noted.
As to physical inactivity (which is very important in maintaining cardiovascular fitness), half at 52.7 percent of women with the youngest ones and the oldest ones are the least active, which is also similar among males indicating that the younger ones are using their fingers more rather than exercising more.
Other factors that maybe important are stress/depression, which is more pronounced among women; pregnancy (effect of hormones and cardiomyopathy), educational attainment, and physician factor (lower rates of CV testing).
“The presence of moderate to severe depression predicted in the presence of CAD in women but not in men. Depressed women (but not men) with CAD had higher risk of death. Impact is higher in younger women (higher post MI mortality),” explained Dr. Gervacio.
In an international survey, the Philippines is the fifth best place to be a woman ranking among Scandinavian countries. However, women’s needs are different and they need special attention.
“There should be an advocacy for women as much as government policies regarding their cardiovascular diseases,” said Dr. Milagros E. Yamamoto, chair of the Women’s Cardiovascular Health lecture during the Philippine Heart Association’s 46th annual convention at the EDSA Shangri-la Hotel.
Vital Signs Issue 76 Vol. 4, June 1-30 2015