DR MAX PEMBERTON: Heart disease is the hidden killer of women over 40. It’s alarming doctors often miss these symptoms. It kills twice as many women as breast cancer. But you can improve your odds

As a champion of women’s fitness and wellbeing, Davina McCall has long been a trusted voice in highlighting important health issues faced by women in mid-life and beyond.

Not only has she been influential in urging women to take the menopause seriously but she’s also been remarkably candid about her brain tumour and breast cancer treatments – speaking out in the hope her experience would help others.

So her disclosure last week, in her podcast Begin Again, that she also has cardiovascular disease, was typically brave as well as important.

Davina, 59, said she’d had high cholesterol for ‘quite a long time’, emphasising that heart disease is rife in women after the menopause – yet it’s an issue that is often overlooked.

Cardiovascular disease, or CVD, is an umbrella term for conditions affecting the heart and blood vessels.

The four main types are coronary heart disease (where the arteries supplying the heart become narrowed by fatty deposits), stroke, peripheral arterial disease (which affects the arteries to the legs) and diseases of the aorta, the body’s main artery. Between them they cause about a quarter of all deaths in the UK, roughly 170,000 a year, which is one every three minutes.

More than eight million Britons are living with CVD, and over four million of them are women. Yet ask most women what they fear most and they’ll say breast cancer.

In fact, coronary heart disease kills more than twice as many women as breast cancer in this country. We still think of the heart attack as a man’s problem – the overweight businessman clutching his chest – and that misconception is costing lives. Research funded by the British Heart Foundation found that women are 50 per cent more likely than men to be given the wrong initial diagnosis when they have a heart attack, and women often wait longer before getting help.

And midlife is when the risk for women changes dramatically. Before the menopause, oestrogen offers a degree of protection, helping to keep blood vessels supple and cholesterol in check. As it falls, that protection goes. A large American study that tracked women through the menopause found that levels of LDL, the so-called bad cholesterol, rise sharply in the year either side of a woman’s final period.

The cruel thing about CVD is that its early stages are usually silent. High blood pressure and high cholesterol cause no symptoms at all, which is why CVD is often only discovered after something has gone wrong.

Chest pain or tightness remain the most common signs of a heart attack, but these may be accompanied by, or overshadowed by, breathlessness, nausea, sweating, light-headedness, or pain spreading to the arm, jaw, neck or back.

Angina, the chest discomfort that comes on with exertion and eases with rest, is another warning the arteries are narrowing, as is getting unusually breathless or exhausted doing things that were once easy.

A woman in her fifties was referred to me because her panic attacks weren’t responding to treatment. She described a tight chest and breathlessness. But when I asked her more, it became clear that the episodes came on when she climbed the stairs or hurried for a bus and eased within a few minutes of stopping. That’s the classic pattern of angina.

I wrote to her GP asking for an urgent referral to the rapid access chest pain clinic, and a scan showed narrowing of the arteries supplying her heart.

The consequences of ignoring CVD are severe.

Untreated, it can lead to heart attack, stroke, heart failure and vascular dementia. But the good news is that most of the risk is modifiable, and the earlier you act the bigger difference it makes.

Start with food. A Mediterranean style of eating – with plenty of vegetables, pulses, wholegrains, oily fish, olive oil, nuts and seeds – has good evidence behind it.

Cut back on saturated fat from processed meat, pastries and cheese, keep salt down, and get plenty of fibre, which helps lower cholesterol. Keep alcohol within the guideline of 14 units a week and, if you smoke, stop.

Aim for at least 150 minutes a week of moderate activity, the kind that leaves you a little out of breath, and add some strength work twice a week.

Look after your sleep, too, and keep an eye on your waistline, as fat around the middle is bad for the heart.

Then get your numbers checked. If you’re aged 40-74 and don’t already have a heart condition, you’re entitled to a free NHS Health Check every five years.

If you haven’t been invited, ask your GP surgery or pharmacy. Tell them if a close relative had heart disease or a stroke before the age of 60.

If your risk is 10 per cent or more, you’ll usually be offered a statin, and I’d urge women not to dismiss them out of hand because of scare stories online.

Above all, if you get chest pain or any other symptoms of a heart attack, call 999. Don’t wait to see if it passes, and don’t worry about making a fuss.

I hope Davina’s revelation gets more women in midlife to improve their heart health.

I’m not alone on ADHD 

After my Channel 4 programme The Great ADHD Myth? this summer, and my article in these pages two weeks ago on the explosion in ADHD diagnoses, I braced myself for the usual backlash. Some were furious but I was also overwhelmed by letters and emails from readers and viewers who share my concerns.

So, I was pleased to see two of the most respected figures in the field add their voices last week. Writing in the British Medical Journal, Professor Dame Uta Frith, a pioneer in autism research, and the clinical psychologist Dr Naomi Fisher argue that private providers are helping to drive the surge.

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

Researchers at two British universities have found that the bacteria and chemicals in our digestive system could help us spot the early signs of dementia. They analysed stool samples from 35 older adults and those with cognitive impairment had a different mix of gut bacteria. The gut and the brain constantly ‘talk’ through the vagus nerve, the immune system and the chemicals gut bacteria produce. It’s another reason to eat a varied diet rich in fibre, which feeds the useful bacteria inside us.

Dr Max prescribes… The Age of Diagnosis

Consultant neurologist Suzanne O’Sullivan asks an uncomfortable question in her excellent book: are we turning too many ordinary human struggles into medical conditions? Drawing on her own patients, she looks at the rise in diagnoses of everything from autism to long Covid and argues that a label can sometimes do more harm than good. It’s compassionate and thought-provoking, and a timely challenge to the idea that more diagnoses always means better care.