The Silent Lady-killer

Posted on Feb 11, 2022

Some women experience warning signs that are unnoticed for weeks or years before a heart problem is diagnosed.

Mrs. Corazon (an alias) was in her early sixties when I first saw her in my clinic. She was having on and off chest heaviness for the past year but she did not mind the symptoms.

“It appears to be due to my gastric reflux,” she told me. But her electrocardiogram revealed something more serious. A dobutamine echocardiogram was thereafter done. It showed a weak heart and the possibility of blocked arteries, predisposing her to a heart attack. Upon my insistent prodding, she agreed to have a coronary angiogram. It was then that we found out she had Coronary Artery Disease involving multiple vessels and thus was a candidate for Coronary Artery Bypass Surgery (CABG).

“I thought heart disease was more common in men,” she said as I explained what needed to be done urgently.

My patient’s story is unfortunately a common narrative about cardiovascular ailment among women. Mrs. Corazon was not alone with this widespread misconception. According to the European Society of Cardiology (ESC), cardiovascular disease accounts for 2 out of 5 deaths in women, portends worse outcomes and results in higher mortality compared to men. From 2011 to 2020, heart disease specifically ischemic heart disease (IHD) remains the number one killer among men and women in the Philippines, according to the Philippine Statistics Authority. In 2021, it remains on top of the list followed by cerebrovascular disease that has almost the same predisposing factors as IHD.

There are many factors why women are at a disadvantage in the diagnosis and treatment of heart disease. These include 1) differences in clinical presentation, with women having more atypical symptoms (like those of gastric reflux) and diagnosed frequently and incorrectly with anxiety disorders rather than organic disease; 2) fewer women subjects are included in clinical trials and studies on heart disease; 3) lack of awareness among women and physicians about sex-specific symptoms pertaining to cardiovascular disease; and 4) the natural tendency of women to prioritize the care of other family members (Source: Women also tend to defer seeking medical attention for chest pain and other possible symptoms pertaining to the heart than males do. This delay results in more complicated cardiac conditions and this necessitates more complex management approaches.

True for both sexes, there are conditions called risk factors that predispose people to the menace of cardiovascular disease. Examples of these are:

  1. Age > 55 for women or post-menopausal women regardless of age; and age > 45 for men

  1. Smoking is considered to be the most preventable cause of death.

  1. Hypertension or increased Blood Pressure - Increased pressure within the blood vessels accelerates damage along its walls.


  1. Elevated Cholesterol – Excess cholesterol may deposit along the walls of blood vessels and cause obstruction.

  1. Diabetes – Elevated blood sugar causes the blood to thicken and flow sluggishly predisposing to blockages in the blood vessels.

  1. Genetics – Familial predisposition is defined by a relative who suffered a heart attack at the age of < 65 for men or < 55 for women.

  1. Sedentary lifestyle – Lack of exercise is associated with obesity, diabetes and hypertension which are risk factors for heart disease.

  1. Obesity increases the incidence of hypertension and diabetes.

  1. Stress increases the secretion of certain hormones and chemicals which may damage the arteries.

  1. Drugs may cause the arteries to spasm or the heart to beat faster (ex: cocaine and methamphetamine)

  1. Pre-eclampsia may increase the risk for future hypertension and infarction.

The best management for heart disease is still prevention. For those who have any predisposing factors such as the above, timely consultation and control of symptoms decrease or even obliterate the risk of complications. At this time and age, medicine has evolved to the extent that heart disease is manageable and compatible with a long productive life.

As for Mrs. Corazon, she continues to see me in my clinic for regular checkups, more than 10 years after her Bypass surgery. She enjoys wonderful days with her grandchildren, exercises on the treadmill, and just like everybody else, frequents the mall on weekends (pre-pandemic, that is) for family bonding time.


If you are a woman and you can identify with the given risk factors, visit us at St. Luke’s Women’s Heart Health Unit to learn how to decrease your risk for cardiovascular disease. Our cardiologists will gladly help you navigate your way towards a healthier and stronger heart.  You are likewise welcome to join our various informative lay fora,  cooking sessions, and exercise classes.

Visit us at the 2nd floor, St Luke’s Medical Center Global City, or call 8-7897700 to learn more about these activities.