When Nicky Clark had a heart attack aged 58, her only symptom had been intermittent heartburn in the weeks leading up to it. “I would have a little flash of heartburn and then it would go away. Then I’d have nothing for a week and then maybe two bouts of heartburn in one day.”

She had never experienced any heart problems, though her brother died of a rare heart condition at 17. She spent most of her life doing what she can to avoid getting Alzheimer’s – to which she lost her mother – not focusing on the angina for which her mum was in hospital when they diagnosed her dementia.

At the time of her heart attack Ms Clark had neither high cholesterol nor high blood pressure, two things she monitored given her family history, and lived a healthy lifestyle in most ways. “I was a very healthy weight, I ate healthily. I’m very boring – I don’t drink or take any recreational drugs or do any scary elite sports. I exercised every single day – fast walking for an hour around my local park.” She did, however, smoke six roll-ups a day, and is a family carer, as well as being a writer, so admits her stress levels were often higher than she would have liked.

“Having a heart attack is the best cure for smoking – I gave up overnight. There was nothing else I could’ve done to prevent this except not smoke, so it was a no-brainer.”

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Things started to unfold one January evening last year. “I was trying to cram a walk in on a very cold day before we went to see a film – Maria with Angelina Jolie, who ironically dies of a heart attack at the end. I was walking up a hill that I’ve walked up many times before and got very sharp heartburn pain. I thought, ‘Oh that’s weird and tried to walk it off.’”

She had no more symptoms until 4.30am the following morning when things suddenly felt much more intense. “It felt like a horse was standing on the middle of my upper chest on one leg. I lost my vision entirely in one eye. In my head I thought, ‘I’m having a heart attack,’ but I didn’t want to say that out loud.

“I started to really really sweat. My husband phoned 111 and it got very serious very fast. Paramedics took me to hospital in a blue-light ambulance. When my husband arrived at the hospital, I just remember apologetically saying to him, ‘I’m ever so sorry but I’ve had a heart attack.’ I felt guilty that I’d caused everybody to worry. I’m the glue that holds everything together, the one that sorts everything out, the mum, the wife, the carer and I felt terrible.”

Ms Clark survived and had a stent fitted – she had suffered mild to moderate damage to her heart: “I was very lucky I didn’t die, not everyone is as lucky as me.” She has since had two more stents fitted and has made a full recovery.

‘Heart attacks are still considered a male thing’

“I’ve been told my heart is back to its pre-heart attack stage,” she says. Following the cardiac rehab programme, she has recently completed Couch to 5K. “I never thought I would enjoy running but I love it. It gives me such a boost to my mental health.” After being advised to stop taking HRT after her heart attack, she has made the decision to go back on the lowest dose there is available.

“Heart disease and heart attacks are still considered a male thing, something that men get in very stressful jobs, and as women, we are the silent victims – especially when they manifest from nowhere,” she says. “There’s a big emphasis on so-called ‘bikini medicine,’ breast cancer – understandably – or reproductive health or menopause – but we rarely talk about cardiac health and women.

“At the time, I was too embarrassed to see my GP about intermittent heartburn, but now I’m evangelical about encouraging women to look out for symptoms like this that don’t go away.”

Research suggests that while men are statistically more likely to experience a heart attack, more women will die from one, something which has been referred to as the “heart-attack gender gap.” According to the British Heart Foundation, twice as many women die from coronary heart disease than breast cancer in the UK. The BHF notes that research suggests women delay seeking help when they experience heart-attack symptoms.

Women are also 50 per cent more likely to receive a wrong initial diagnosis when they are having a heart attack. And one 2018 study estimated that more than 8,000 women in England and Wales died over a 10-year period due to unequal heart-attack care.

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“Heart disease in women isn’t rare, but it is often hidden,” says consultant cardiologist Dr Nabila Laskar. “That’s why it’s really important to advocate for yourself and push to have your voice heard if something doesn’t feel right.”

There are a number of risk factors for heart disease, including high cholesterol, high blood pressure, diabetes, smoking and family history. “Many people don’t understand the importance of family history,” Laskar says.

“If any first-degree relative like your mother, father or siblings has experienced heart disease, that’s a warning sign. Some people may never get any symptoms and it’ll just happen suddenly.” Age is another risk factor. “And for women, after menopause there is less protection from heart disease. The oestrogen that was protecting you a little bit has dropped, so some postmenopausal women develop heart problems around this time.”

Clearly more needs to be done to improve detection of heart disease in women. A new study published in the medical journal Heart by specialists in Australia suggests breast mammograms could one day be used to shed light on heart health by spotting those most at risk. A heart attack is caused by a narrowing of the arteries supplying your heart due to fatty plaque build-up. If someone has plaques in their heart arteries, there may also be plaques in blood vessels elsewhere – including in the breasts, the researchers found.

“It allows us to look for more than one thing during breast screenings,” says Laskar of the research. “But lots of women don’t have a traditional calcification of plaque, or furring up of arteries, that we typically see in men, so it can be harder to visualise on traditional scans.”

‘Push to see a specialist’

Historically there has been a significant under-representation of women in research and clinical trials into heart health. “So far it has only focused on males so we don’t have much data on how best to treat women and how best to risk stratify based on their medical history so that we can identify those at higher risk,” Laskar adds.

Women don’t always present with classic heart-attack symptoms, which is part of the problem, she says. “Women often present with atypical symptoms or symptoms that overlap with other things. Things like nausea or just jaw pain or just upper back pain or fatigue or breathlessness or even abdominal pain – so it’s a diagnostic conundrum.

“If you have atypical symptoms and are advised to monitor things by a health professional, but it doesn’t go away, my advice is to push to see a specialist. That could be the difference between having a heart attack that we could prevent and treat well in advance, and quite serious damage to your heart.”

The 5 best ways to look after your heart

Do regular cardio exercise

“The heart is a muscle we have to exercise it so it remains healthy. We always suggest running, cycling or swimming for a total of 150 minutes per week. Strength training two or three times a week is a good addition.”

Monitor blood pressure carefully

“People who get anxious having it measured at their GP surgery [can] end up with very high blood pressure readings as a result. They may be started on treatment which they don’t need because their home blood pressure is normal. On the other hand, there are people who measure their blood pressure every day and become quite anxious about any variation. It’s about doing it appropriately.”

Prioritise sleep

“A reduction in sleep over time has been associated with heart disease. People who work in highly stressful jobs for long hours, go out with work colleagues, and then wake up early to do an intensive workout are often sacrificing their sleep. If that goes on for a long time, it could contribute significantly to your cardiovascular disease risk.”

Eat a balanced diet

“We now have an epidemic of metabolic syndrome, where many people are being diagnosed with pre-diabetes because of weight gain.” Following a balanced diet rich in a variety of fruit and veg, beans, nuts and seeds, less red or processed meat, less saturated fat and less salt is key.

Manage stress well

“We know stress can cause things like stomach ulcers, as well as heart problems. No one knows how stress is going to manifest in your body. We all live quite stressful lives, but try to remember that whatever it is, it isn’t worth your health. We really should prioritise rest and recovery.”