DR ELLIE: Why countless seemingly healthy middle-aged women are at risk of deadly heart attacks – just like the beloved Vicar of Dibley star Emma Chambers who died at just 53

For women in their 50s, much of the health conversation for the past few years has been about one thing: menopause.

HRT, hot flushes, brain fog, bone strength.

All important. But a far bigger threat is being ignored, and it kills twice as many British women every year as breast cancer.

Heart disease.

In my surgery, I have seen women genuinely shocked when I raise it. They eat well, they walk the dog, they feel fine. Surely heart attacks happen to overweight men?

That belief is dangerous. In Britain we have long treated heart attacks and cholesterol as a male problem. I have always loathed those health posters of a middle-aged man clutching his chest, as if women simply don’t feature.

The consequences are real. According to the British Heart Foundation, women are 50 per cent more likely than men to be given the wrong initial diagnosis for a heart attack. Women are also less likely to recognise it could be happening to them, leading to delays in treatment that cost lives.

It’s a fate that befell The Vicar of Dibley and Notting Hill actor Emma Chambers who in 2018 died of a heart attack aged just 53.

Here is why it matters. Heart disease becomes markedly more common in women after the menopause. The female sex hormone oestrogen protects the heart. When levels fall, the risk climbs.

Women who go through an early menopause lose that protection sooner, so spend more years at higher risk. The menopause years can also often bring weight gain and less exercise too, both of which add to the danger.

And that stubborn tummy fat – sometimes unflatteringly referred to as meno-belly? It is not just demoralising. Fat around the middle is a risk factor for cardiovascular disease – the umbrella term for heart attacks, strokes and angina. All happen when the arteries get clogged up and blood can’t get where it needs to go.

In a heart attack or stroke, the supply is completely blocked, and unless it is restored fast the results can be fatal. In angina the flow is reduced, causing chest pain and tightness, a major warning sign that a heart attack may follow.

Some risk factors can’t be changed. Family history and ethnicity are big ones. But women have extra ones that doctors rarely ask about: starting your periods early, recurrent miscarriages and pregnancy complications such as high blood pressure.

If any apply to you, tell your GP. Don’t wait to be asked, because you probably won’t be.

This is how a seemingly healthy woman can be quietly at risk.

Women in England aged 40 to 74 are entitled to a free NHS Health Check every five years, designed to spot exactly these concerns. If you have been invited, go. If you haven’t, ask your GP about it.

The good news is that the biggest risk factors – cholesterol, blood pressure and diabetes – are what we call modifiable. We can bring them down with lifestyle changes, such as an improved diet and regular exercise. And it doesn’t mean a joyless low-fat diet. The best cholesterol-lowering diets are often about adding things in: nuts, seeds, olive oil and avocados all help. Oats and soya are excellent.

If this isn’t sufficient, then medications such as statins can help.

However, high blood pressure deserves special attention. Women are less likely than men to have it, but research suggests that when they do it raises their risk of a heart attack more than it does for men. That makes treating it vital.

Know your numbers. I recommend buying your own blood pressure monitor, or you can get checked free at your GP surgery and at many pharmacies.

If your GP suggests tablets, please take them. But exercise, losing weight and cutting back on salt and alcohol will all help bring readings down.

Stress matters too. I will never forget one patient who was able to stop all three of her blood pressure medications after she retired from a very stressful teaching job.

Menopause deserves every bit of the attention it has had – but your heart deserves the same.

Men should not be ashamed for using weight-loss injections 

I don’t think we discuss enough the benefits of weight-loss jabs for men. Just as heart disease is treated as a men’s issue, these extraordinary drugs are often viewed as a treatment for women. There are even weight-loss medication companies, such as SheMed, specifically targeted at women.

But as far as I can tell, there aren’t any firms focused on selling these drugs directly to men.

I have a few male patients who take these appetite-suppressing injections but, often, they are sheepish or embarrassed about doing so. This comes from the fact that men are told that the only socially acceptable way for them to lose weight is to do sport and go to the gym rather than get medical help.

It’s time we changed this attitude, as there are countless men who would see their lives improved – not to mention extended – by jabs.

Are you a man who has taken weight-loss drugs? Did you feel embarrassed to take them? Please email DrEllie@mailonsunday.co.uk and let me know.

Your questions answered

I’ve been plagued with sexual problems since I started taking tablets for my enlarged prostate. What should I do?

Dr Ellie replies: For some patients, the side-effects of taking medication for an enlarged prostate can be more unpleasant than the condition itself – meaning that it might be worth giving them up.

An enlarged prostate is one of the most common medical problems for men over the age of 60. Throughout life, the prostate gland – which sits directly below the bladder and helps to produce semen – continues to grow.

But it means that by the time men are in their 60s, it can start to press against the tube that carries urine from the bladder, leading to an array of symptoms. This includes frequent trips to the loo – particularly at night – and difficulty passing urine.

When the condition becomes disruptive, many men are offered medication, the most common of which are tamsulosin and finasteride. These drugs – taken daily – are effective at easing the symptoms of an enlarged prostate, but they can also trigger sexual problems, such as difficulty holding an erection.

One solution is to take an erectile dysfunction drug, such as sildenafil, also known as Viagra.

Another option is surgery to remove part of the prostate, which usually eases the symptoms. But this is not risk-free either and surgery can, in some cases, lead to lasting sexual issues.

However, if patients believe that the sexual problems are more disruptive than the enlarged prostate symptoms, they can simply decide, with the help of their GP, to come off the tablets.

An enlarged prostate is not a life-threatening condition, so this decision is ultimately about what makes the patient most comfortable. 

Do you have a question? Email DrEllie@mailonsunday.co.uk