In light of the sobering facts presented last week, it remains essential to detect heart disease in women before the onset. The most significant risk factors for the development of heart disease are: hypertension, smoking, diabetes mellitus, dyslipidemia (elevated cholesterol), family history of coronary artery disease or stroke and advanced age.
In women, a low HDL (good cholesterol) is more predictive of heart disease than high LDL (bad cholesterol).
Additionally, elevated triglycerides are a particularly significant risk factor for heart disease in premenopausal women and in women with triglycerides greater than 400 mg/dL. Smoking is particularly important in women, as it has been implicated in over one half of all women with heart disease.
However, the risk of heart attacks in women who stop smoking returns to that of a life long non-smoker within three years of stopping. Women are particularly at risk of future coronary artery disease if they are obese, especially those with central or abdominal obesity.
In a study of more than 100,000 female nurses, the risk of heart disease mortality was directly proportional to their level of obesity. This article is not written to comprehensively diagnose heart disease in women, therefore, it is critical that all women be screened for these established risk factors.
The postmenopausal state and hormone replacement therapy in heart disease are still very controversial. Coronary artery disease remains relatively uncommon in premenopausal women.
Yet the rates of coronary heart disease seem to rise rapidly when women enter the postmenopausal state, regardless of the age at which menopause starts.
However, this in no way implicates the hormonal changes of menopause as the cause of coronary heart disease.
The fact remains that the timing of menopause often correlates with the increased incidence of the above listed risk factors for coronary artery disease.
Once more, a recent study showed an absence of statistical benefit to hormone replacement therapy in postmenopausal women to reduce the risk of coronary artery disease when compared to placebo. The estrogen/progestin therapy, when prescribed solely for prevention of future heart disease, had no significant reduction in the long-term rates of coronary heart disease. This remains a very personal decision that can only be made after a long discussion with your health care provider.
The essential diagnostic tests to detect heart disease in women is relatively similar to those in men, with the understanding that there remains some differences. The most recent guidelines put forth by the American Heart Association and the American College of Cardiology support exercise stress testing for the evaluation of chest pain.
The difference being that women have a higher rate of false positive test results (positive stress test when no coronary heart disease is present) then men. Sadly, a number of studies have demonstrated that women with abnormal stress tests, as compared to men, have lower rates of being sent for diagnosis and possible treatment with a coronary angiogram. One study showed that women with a positive stress test who did not have a coronary angiogram had a higher three-year follow up rate of heart attack and death.
In light of the above, the current recommendations to prevent the development of coronary artery disease include some very basic principles. Firstly, all women should engage in moderate level physical exercise for roughly 30 minutes every day. Smoking cessation is critical, either alone or as part of a smoking cessation support group. Weight reduction to target body-mass-index, in conjunction with a heart healthy diet is critical. In addition, all women should have baseline fasting serum cholesterol profile, with aggressive therapy to reach target cholesterol levels. Finally, like their male counterparts, all women should have pristine hypertension and diabetes control.
To highlight this great disparity, the American Heart Association initiated the “Go Red for Women” campaign. Since its inception in 2004, the goal has been to educate people to the risks of heart disease in women and improve care. One day each year, Americans are encouraged to show their support by wearing something red.
This year, Friday, Feb. 6, 2009 will be National Wear Red Day. However, each day, Americans should realize that heart disease is the number one killer of women. Working with your health care provider and taking the appropriate steps can truly change your life and allow you to lead a heart healthy life.
Dr. David M. Donaldson is an Auburn native and currently a
cardiologist at Massachusetts General Hospital in Boston
Additionally, elevated triglycerides are a particularly significant risk factor for heart disease in premenopausal women and in women with triglycerides greater than 400 mg/dL. Smoking is particularly important in women, as it has been implicated in over one half of all women with heart disease.
However, the risk of heart attacks in women who stop smoking returns to that of a life long non-smoker within three years of stopping. Women are particularly at risk of future coronary artery disease if they are obese, especially those with central or abdominal obesity.
In a study of more than 100,000 female nurses, the risk of heart disease mortality was directly proportional to their level of obesity. This article is not written to comprehensively diagnose heart disease in women, therefore, it is critical that all women be screened for these established risk factors.
The postmenopausal state and hormone replacement therapy in heart disease are still very controversial. Coronary artery disease remains relatively uncommon in premenopausal women.
Yet the rates of coronary heart disease seem to rise rapidly when women enter the postmenopausal state, regardless of the age at which menopause starts.
However, this in no way implicates the hormonal changes of menopause as the cause of coronary heart disease.
The fact remains that the timing of menopause often correlates with the increased incidence of the above listed risk factors for coronary artery disease.
Once more, a recent study showed an absence of statistical benefit to hormone replacement therapy in postmenopausal women to reduce the risk of coronary artery disease when compared to placebo. The estrogen/progestin therapy, when prescribed solely for prevention of future heart disease, had no significant reduction in the long-term rates of coronary heart disease. This remains a very personal decision that can only be made after a long discussion with your health care provider.
The essential diagnostic tests to detect heart disease in women is relatively similar to those in men, with the understanding that there remains some differences. The most recent guidelines put forth by the American Heart Association and the American College of Cardiology support exercise stress testing for the evaluation of chest pain.
The difference being that women have a higher rate of false positive test results (positive stress test when no coronary heart disease is present) then men. Sadly, a number of studies have demonstrated that women with abnormal stress tests, as compared to men, have lower rates of being sent for diagnosis and possible treatment with a coronary angiogram. One study showed that women with a positive stress test who did not have a coronary angiogram had a higher three-year follow up rate of heart attack and death.
In light of the above, the current recommendations to prevent the development of coronary artery disease include some very basic principles. Firstly, all women should engage in moderate level physical exercise for roughly 30 minutes every day. Smoking cessation is critical, either alone or as part of a smoking cessation support group. Weight reduction to target body-mass-index, in conjunction with a heart healthy diet is critical. In addition, all women should have baseline fasting serum cholesterol profile, with aggressive therapy to reach target cholesterol levels. Finally, like their male counterparts, all women should have pristine hypertension and diabetes control.
To highlight this great disparity, the American Heart Association initiated the “Go Red for Women” campaign. Since its inception in 2004, the goal has been to educate people to the risks of heart disease in women and improve care. One day each year, Americans are encouraged to show their support by wearing something red.
This year, Friday, Feb. 6, 2009 will be National Wear Red Day. However, each day, Americans should realize that heart disease is the number one killer of women. Working with your health care provider and taking the appropriate steps can truly change your life and allow you to lead a heart healthy life.
Dr. David M. Donaldson is an Auburn native and currently a
cardiologist at Massachusetts General Hospital in Boston
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