Dr Max: Heart Disease Signs Often Missed in Women Over 40

Davina McCall has become a powerful advocate for women’s fitness and wellbeing, using her public profile to draw attention to health concerns that can affect women during middle age and later life.

She has repeatedly urged women to take menopause symptoms seriously and has also spoken with striking openness about her own brain tumour and breast cancer treatment, hoping that sharing her experiences might encourage others to seek help.

That made her latest revelation on her Begin Again podcast all the more significant. Davina revealed that she is also living with cardiovascular disease, offering another candid warning about a condition that is often underestimated in women.

The 59-year-old said she had been dealing with high cholesterol for “quite a long time” and stressed that heart disease becomes increasingly common for women after menopause, despite receiving far less attention than it deserves.

Cardiovascular disease, usually shortened to CVD, describes a range of illnesses affecting the heart and the network of blood vessels.

Its four main forms are coronary heart disease, caused by fatty deposits narrowing the arteries that supply the heart; stroke; peripheral arterial disease, which affects blood flow to the legs; and conditions involving the aorta, the body’s largest artery. Together, these illnesses account for around one in four deaths in the UK – approximately 170,000 each year, or one every three minutes.

More than eight million people in Britain have CVD, including over four million women. Yet when women are asked which illness they fear most, breast cancer is often the first answer.

The reality, however, is that coronary heart disease kills more than twice as many women as breast cancer in the UK. Many people still imagine a heart attack as something that happens mainly to an overweight male executive clutching his chest. That outdated image can be dangerous. British Heart Foundation research found that women are 50 per cent more likely than men to receive an incorrect initial diagnosis during a heart attack, while delays in seeking or receiving treatment are also common.

For women, the transition through midlife can bring a marked change in heart risk. Before menopause, oestrogen provides some protection by helping blood vessels remain flexible and supporting healthier cholesterol levels. When oestrogen declines, so does that benefit. A major US study following women through menopause found that LDL, often described as “bad” cholesterol, climbs sharply around the time of a woman’s final period.

One of the most troubling features of CVD is that it can develop without obvious warning. High blood pressure and raised cholesterol generally cause no symptoms, meaning the disease may only be detected after serious damage has occurred.

Chest pain or pressure remains the best-known sign of a heart attack, but women may also experience breathlessness, nausea, sweating or dizziness. Pain can travel into the arm, jaw, neck or back and may be more noticeable than the chest discomfort itself.

Angina is another important warning. The discomfort typically appears during physical effort and improves after resting, suggesting that the arteries supplying the heart have become narrowed. New or unusual breathlessness and fatigue during activities that were previously manageable should also be taken seriously.

I once saw a woman in her fifties who had been referred because her supposed panic attacks were not improving. She described a tight feeling in her chest and difficulty breathing. But further questioning revealed that the episodes began when she climbed stairs or rushed to catch a bus and settled within minutes of stopping. That pattern was far more consistent with angina than anxiety.

I contacted her GP and requested an urgent appointment at a rapid-access chest pain clinic. A scan subsequently confirmed that the arteries supplying her heart were narrowed.

The potential consequences of overlooking cardiovascular disease are serious.

Without treatment, CVD can result in a heart attack, stroke, heart failure or vascular dementia. There is, however, encouraging news: much of the risk can be reduced, and taking action early offers the greatest benefit.

Diet is a good place to begin. Evidence supports a Mediterranean-style eating pattern built around vegetables, beans and other pulses, wholegrains, oily fish, olive oil, nuts and seeds.

Try to reduce saturated fat found in processed meats, pastries and cheese, limit salt and include plenty of fibre, which can help bring cholesterol down. Alcohol should remain within the recommended maximum of 14 units a week, while smokers should make every effort to quit.

Aim to complete at least 150 minutes of moderate exercise each week – enough to leave you slightly breathless – and include strength-building activities on two days.

Quality sleep matters too. It is also worth keeping track of your waistline, since excess fat around the abdomen is linked to poorer heart health.

Regular health checks can identify hidden risks. Anyone aged 40 to 74 without an existing heart condition is entitled to a free NHS Health Check every five years.

If you have not received an invitation, contact your GP practice or local pharmacy. Make sure to mention a close family history of heart disease or stroke, particularly if it occurred before the age of 60.

People whose calculated cardiovascular risk is 10 per cent or higher will generally be offered a statin. Women should not automatically reject the medication because of alarming claims circulating online; a discussion with a healthcare professional can help weigh up the benefits and risks.

Most importantly, call 999 immediately if you develop chest pain or other possible heart attack symptoms. Do not wait for them to disappear and do not be concerned about making an unnecessary fuss.

I hope Davina’s honesty encourages more women in midlife to take their heart health seriously.

I’m not alone on ADHD 

Following my Channel 4 programme, The Great ADHD Myth?, broadcast this summer, and my article two weeks ago about the rapid rise in ADHD diagnoses, I expected a familiar wave of criticism. Some viewers were angry, but I was also inundated with messages from readers and viewers who said they shared my concerns.

It was therefore reassuring to see two highly respected specialists express similar worries last week. In the British Medical Journal, autism research pioneer Professor Dame Uta Frith and clinical psychologist Dr Naomi Fisher argued that private healthcare providers may be contributing to the growth in diagnoses.

‘Convincing more people they could be autistic or have ADHD is a marketing strategy to increase their customer base,’ they wrote. Health Secretary Yvette Cooper has said that all ADHD and autism assessments will be regulated by the Care Quality Commission.

Research from two British universities suggests that the bacteria and chemicals in the gut may eventually help identify early signs of dementia. Scientists examined stool samples from 35 older adults and found that those with cognitive impairment had a different balance of gut bacteria. The digestive system and brain communicate continuously through the vagus nerve, the immune system and substances produced by gut microbes. It is another reason to eat a varied, fibre-rich diet, which helps nourish beneficial bacteria.

Dr Max prescribes… The Age of Diagnosis

In her compelling book, consultant neurologist Suzanne O’Sullivan explores an uncomfortable possibility: are too many ordinary human difficulties being reclassified as medical disorders? Drawing on her clinical experience, she examines the growing number of diagnoses linked to conditions including autism and long Covid, and considers how a label can sometimes create harm as well as support. Compassionate and thought-provoking, the book offers a timely challenge to the assumption that increasing the number of diagnoses will always lead to better care.