Bệnh tim mạch bao gồm bệnh nghẽn mạch vành tim và bệnh tai biến mạch máu não, là bệnh làm chết nhiều người nhất ở Hoa Kỳ và nhiều nước trên thế giới. Ở Hoa Kỳ, hơn 40% bệnh nhân đàn bà chết vì bệnh tim mạch mỗi năm.  Bệnh tim mạch không được phổ biến cho phụ nữ như những bệnh nhân phái nam.

Viện Gallup đã khảo cứu phụ nữ vào năm 1995 và thấy rằng 80% phái nữ không biết bệnh tim mạch là nguyên nhân chết người nhiều nhất của dân Hoa Kỳ. Mặc dù bệnh tim mạch rất nguy hiểm và ảnh hưởng nhiều người hơn, nhưng nó không được phụ nữ để ý nhiều như bệnh ung thư vú hay những bệnh ung thư khác.

Mục đích của bài này là giúp cho bệnh nhân phụ nữ và gia đình biết đến những vấn đề quan trọng và đặc biệt về bệnh tim mạch của phái nữ.Bài này sẽ chú trọng về bệnh nghẽn mạch vành tim và những vấn đề liên hệ.

Vậy bệnh tim mạch là gì?

Tim chúng ta có ba mạch chính bao quanh và dẫn đến cơ tim để nuôi nó. Mỗi mạch nuôi một phần của tim. Nếu có một hoặc nhiều mạch bị nghẽn thì cơ tim sẽ thiếu máu và có thể bị hư.  Bác sĩ gọi cơ tim hư này là nhồi máu cơ tim (heart attack).

Bệnh nghẽn mạch vành tim có thể giết ta nhanh hay chậm. Nếu mạch lớn bị bịt bất thình lình thì tim có thể ngưng đập lập tức. Nếu mạch lớn bị nghẽn từ từ thì tim sẽ yếu đi chậm và dẫn đến bệnh suy cơ tim. Một khi cơ tim bị chết và trở thành sẹo thì sẽ không trở lại bình thường nữa.

Những yếu tố dẫn đến bệnh nghẹt mạch tim là gì?

• Bệnh tiểu đường là một trong những bệnh nguy hiểm và dễ dẫn đến bệnh tim mạch.  Lượng đường trong máu cao sẽ làm cho vành mạch máu đông chất mỡ cholesterol nhanh hơn.

• Bệnh cao huyết áp.  Bệnh này cũng dẫn đến mạch máu bị nghẽn chất mỡ cholesterol nhanh hơn. Hơn nữa, bệnh cao huyết áp làm dễ bị tai tiến mạch máu não và suy thận.

• Bệnh cao mỡ cholesterol.  Bệnh này nếu không trị cũng dễ dẫn đến mạch máu bị nghẽn. Lượng mỡ tốt HDL thấp là yếu tố quan trọng nhất trong vấn đề này. Cao lượng cholesterol tổng cộng hay lượng triglycerides cũng không tốt. Hơn nữa, lượng triglycerides cao ảnh hưởng xấu cho bệnh nhân nữ nhiều hơn bệnh nhân phái nam.

• Hút thuốc lá. Thói quen này làm mạch máu dễ bị nghẽn và cũng gây ra nhiều bệnh khác như hư phổi hay ung thư. Hút thuốc 3 đến 5 điếu cũng có thể dẫn đến bệnh tim. Những bệnh nhân bỏ hút thuốc hơn ba năm sẽ có tỷ lệ bệnh tim bằng những bệnh nhân không hút thuốc.

• Tuổi già.  Mặc dù bệnh nhân nữ bị nghẽn tim mạch trễ hơn phái nam, nhưng sau 75 tuổi thì tỷ lệ bệnh cũng tương đương.

• Mặc dù yếu tố di truyền không ảnh hưởng phụ nữ nhiều bằng phái nam, nó cũng là một yếu tố quan trọng làm dễ bị bệnh tim mạch. Nếu một nữ bệnh nhân có cha hay mẹ bị nhồi máu cơ tim sớm thì tỷ lệ bệnh tim mạch của họ sẽ tăng lên gấp 3 lần.

• Ít tập hoặc hoạt động thể thao. Những bệnh nhân này sẽ dễ bị bệnh tim mạch. Tuy nhiên, nếu họ thay đổi thói quen và tập thường lệ thì sẽ ít bị bệnh tim hơn.

• Bệnh mập làm tăng tỷ lệ bị nghẽn mạch tim và bệnh tiểu đường hay cao huyết áp.

• Bệnh buồn (depression) có khuynh hướng tăng tỉ lệ chết cho những bệnh nhân về tim mạch.

Những yếu tố đặc biệt về bệnh tim của phụ nữ là gì?

• Thuốc ngừa thai. Thuốc ngừa thai thuộc loại kích thích tố nữ. Những loại thuốc này làm máu dễ đông hơn bình thường và dễ dẫn đến nghẽn tĩnh mạch chân hay mạch phổi. Hơn nữa, nó làm tăng chất mỡ phụ triglycerides.

• Thời kỳ mãn kinh.  Phái nữ đến lúc mãn kinh sẽ có những thay đổi về chất kích thích tố trong người. Chất hormones sẽ bị giảm và điều này sẽ dẫn đến bệnh tim mạch dễ dàng hơn.  Tuy nhiên, uống chất hormones không giúp giảm bệnh tim mà có thể làm hại nữa.

• Thuốc kích thích tố nữ (hormones Estrogen và Progestin).Theo cuộc khảo cứu Heart and Estrogen/Progestin Study (HERS) gần đây, thuốc hormones Estrogen/Progestin cho nữ bệnh nhân mãn kinh làm dễ bị đông máu tĩnh mạch.

Cuộc khảo cứu Women’s Health Initiative (WHI) bị ngưng sớm vì tỷ lệ bệnh ung thư vú và có thể tăng tỉ lệ bệnh tim, nhất là trong năm đầu sau khi uống thuốc hormones.

Vì kết quả trên, bác sĩ chỉ khuyên bệnh nhân uống thuốc hormones nếu họ bị những triệu chứng mãn kinh nặng (như nóng mặt v.v..).  Những trường hợp khác thì tuỳ bệnh nhân quyết định.

Nói tóm lại, bệnh tim mạch cũng rất thông thường và quan trọng cho phái nữ.  Có nhiều yếu tố làm dễ bị bệnh tim mạch cho cả phái nam lẫn phái nữ như tiểu đường, cao huyết áp, cao mỡ cholesterol, hay hút thuốc, di truyền.  Cũng có những yếu tố đặc biệt cho bệnh nhân nữ như tuổi tác, mãn kinh, hay thuốc kích thích tố nữ.


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