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As blanket media coverage today reprimanded doctors for missing ‘clear symptoms’ of deadly heart disease in pregnancy (as maternal death rates linked to cardiac problems have doubled since the 1980s), and warned all pregnant women to watch for heart disease, none of the articles delved into why women are at increased risk during certain stages in their life and how they can better protect themselves. So for anyone now fearful or uncertain, please read on…
The cardiovascular risk for pregnant and postpartum women
The Confidential Enquiry into Maternal Deaths, led by experts at Oxford University, found a quarter of maternal deaths are linked to cardiovascular disease. Their conclusion was: ‘This report highlighted many instances when pregnant and postpartum women had clear symptoms and signs of cardiac disease, which were not recognised, often because the diagnosis was simply not considered in a young pregnant woman’. As such, they issued new guidance to all pregnant women to ‘expect to have your blood pressure and urine tested at every antenatal visit. Make sure this is happening. If it is not, ask why not.’
Whilst the actual numbers who die are small (2.18 women per 100,000 between 2012-2014, or roughly 17 per year), experts have long warned that cardiovascular problems are more likely to be missed among women than men. It’s therefore vital that women themselves understand the times at which they are greater risk, to ensure they can better protect themselves.
Whilst many take blood flow for granted, and think that if their heart is pumping then their blood must be circulating smoothly too, this is NOT always the case and the simple truth is that women’s blood flow is more prone to problems than men. Women and men are not the same when it comes to their blood platelets. Women tend to have more and these tend to become stickier more easily (which can cause clotting). Whilst we’re all prone to sticky platelets as they’re heavily influenced by our lifestyles (exercise levels, diet, stress etc), our age, and hormonal factors; lifestyle issues, which cause platelet stress, are enhanced in women. This means women’s platelets tend to respond more strongly to lifestyle and diet stress than men’s. Add to that the fact that hormonal factors are more prevalent in women (due to menstruation, pregnancy and menopause) and the true heart disease risk for women becomes clearer.
When women are at greater cardiovascular risk
The most obvious times when women’s platelets are stickier is mid-menstrual cycle; in women who take a contraceptive based on progesterone; during pregnancy and post menopause. Hormones can cause women’s platelet function to see-saw every month, with platelets refusing to clot so easily during menstruation and the early part of the cycle, then becoming hyperactive as progesterone levels rise.
Extended hormone disruption, as occurs in pregnancy, results in all women having hyperactive platelets during this time. This gives a higher than normal risk of thrombosis (DVT and varicose vein development) and blood clotting. A recent BBC article indicated that 29 per 10,000 women will experience a vein thrombosis event whilst pregnant. And for women in the post-partum period – in the weeks just after they have given birth – their risk is about 300-400 in 10,000. To put this into perspective, if you’re a woman of reproductive age and you’re not on a hormonal contraception, your risk is only about two in 10,000 women per year. Yet CVD symptoms can be masked by pregnancy and thus missed.
What is also little known, is that taking a contraceptive pill containing progesterone can give rise to similar effects as pregnancy, and the risk of thrombosis increases after as little as three months usage. In young women less than 25, taking the contraceptive pill long term (for more than 18 months) raises thrombosis risk so it’s similar to that typical of a woman over 50. Again, the BBC article indicated that about three to 10 per million women die as a result of having a clot that is attributable to use of their combined hormonal contraception.
As for the risks posed to women during the post menopausal stage – that’s worthy of a whole other blog post so please watch this space! This is the period in women’s lives when they are, in fact, at greatest risk.
How women can better protect themselves from cardiovascular disease
So what can women do to combat this risk and protect themselves whilst on the contraceptive pill, pregnant or postpartum? On top of the new guidelines that pregnant women should make sure they have their blood pressure and urine tested at every antenatal visit; getting your blood pressure, blood sugars and cholesterol levels measured at anytime will give you a basic idea of what’s going on internally. People know about cholesterol and blood pressure but there is little information on how to keep your blood flow healthy. Yet understanding and managing blood flow and taking steps to keep it healthy, is a vital step in maintaining cardiovascular health. And taking care of it when you’re younger can ensure it will continue to flow smoothly throughout your life. If you’re on this website, you’re on the right track. So gen up on why blood flow is so important to your cardiovascular health and check here on what you can do to protect or help it.
 https://www.theguardian.com/lifeandstyle/2016/dec/07/pregnant-women-uk-warned-heart-disease-symptoms; http://www.dailymail.co.uk/news/article-4007684/Pregnant-women-dying-doctors-miss-clear-symptoms-heart-disease.html