Womens Heart Health

Published in the Beebe Beacon

Heart to Heart

Women can take steps to make sure the beat goes on

By Karen M. Jones

Are you the type to have a heart attack? If you're a woman, you might be inclined to answer "no" automatically,

assuming that heart attacks happen to middle-aged, overstressed, perhaps overweight men. But if you're past the age of menopause, you're more at risk than you might think. Heart disease, in fact, is the number one killer of

American women.

The National Heart, Lung, and Blood Institute (NHLBI) says that one in three women dies of heart disease every year. And if you've been more worried about breast or other female cancers, you should know that heart disease kills more women over 65 than all cancers combined. Yet less than a third of women surveyed know that heart disease is the leading cause of death for their gender.

Up until recently, the condition has been linked with men because they were the only ones studied. Dr. Pedro Perez, a cardiologist with Delaware Cardiovascular Associates in Lewes, says that early research was focused on men because heart disease was so much more common in males than in females - before menopause. "Early

studies looked at the younger person - 40, 50, 60 years old," Dr. Perez explains, "and at that age range, the

prevalence of heart disease is higher in males than in females. After menopause, the risk increases high enough that the female and male risk is about the same."

Are You at Risk?

The most common heart disease is coronary artery disease - blockages in the arteries that carry blood and

oxygen to the heart. When the blood supply to part of the heart muscle itself is severely reduced or stopped, heart attack occurs. Other, much less common problems involve the heart muscle itself, the valves and the heart's rhythm.

While risk factors generally are the same for men and women, Dr. Evagoras Economides, a cardiologist with

Cardiology Consultants in Lewes, says there are subtle differences in how some of those factors affect each gender. Among the influences on your heart health are:

> Family history. Children of parents with heart disease are more likely to develop it themselves. A family history of diabetes, gout, high blood pressure or high blood cholesterol also increases the risk of heart disease.

> High blood pressure. "Believe it or not, 80% of women over the age of 75 have high blood pressure," says Dr. Economides.

> High cholesterol. "In women, the total cholesterol and the "bad" (LDL) cholesterol levels are less important than the so-called "good" cholesterol or HDL," he says.

> Diabetes. "Diabetes completely eliminates the [pre-menopausal] female advantage. So a diabetic woman at any age is as much at risk for heart disease as [a post-menopausal woman]," he says.

> Obesity. According to the American Heart Association, people with excess body fat, especially concentrated around the waist, are more likely to develop heart disease and stroke, even if they have no other risk factors.

> Smoking. Dr. Economides says that smoking rates are falling among men, but are rising in women.

> Lack of exercise. "In one study, a lower fitness level was associated with almost a fivefold increase in

arteriosclerosis (the buildup of fatty substances in the arteries) in women," he says.

> Social support: "A lack of social support [that causes stress or depression] may have more impact on women than men," Dr. Economides explains. "It's important because women are more likely to survive the death of their partners."

At the Heart of Hormones

The one factor that is unique to women is hormones. Before menopause, the female hormone estrogen provides protection against heart disease. Some women lose this protection prematurely, such as women who, early in their lives, have a

hysterectomy in which their ovaries are removed; they are at higher risk than other women before menopause. Women who take oral contraceptives also alter the hormonal mix. "The cardiac risk is negligible," says Dr. Economides. "It increases, though, in women over 35 and women who smoke. So those women should be careful."

Perhaps the biggest surprise most recently is the role of hormone replacement therapy, or HRT, in post-menopausal women. "In the past," says Dr. Perez, "it was felt that the incidence of heart disease in women was lower than in men before menopause because they were protected by hormones. Once they are past the age of

menopause, and they lose the hormones produced by their ovaries, then the incidence of heart disease increases. So it's easy to see how people, putting two and two together, thought that replacing the hormones would be

protective to the heart. So people started getting this medication not simply for treatment of hot flashes with

menopause, but even as prevention of heart disease or strokes."

Dr. Hannah Akiki, a cardiologist with Henlopen Cardiology in Lewes, explains how things changed suddenly. "The HERS (Heart and Estrogen-Progestin Replacement) Study and another large recent study came to the conclusion that hormone replacement will definitely increase the risk of breast cancer, stroke and cardiac events. The only

benefit that's still really significant is on bone density, preventing a higher number of hip fractures or vertebral

fractures. But that could be treated in different ways such as with calcium and vitamin D, and also other bone

medications."

And what if one of his heart patients is taking HRT? "I'll stop it," he says emphatically.

Says Dr. Perez, "The current recommendation by the AHA is that [HRT] should not be indicated for primary

prevention of heart disease, and it should not be given to someone who already has heart disease. The woman out there who's already taking hormone therapy needs to speak with her own physician to go over her case individually. But with the data available now, if a patient of mine with a heart attack in the past comes in and she's taking that combination of progestin and estrogen, my recommendation is to stop it."

HRT was just one risk for Sharon Russell, age 65, of Dagsboro. "I took [HRT] for years because I thought it was good for my heart," she says. "But I went off it the week that study came out." Heart disease runs in Mrs. Russell's family. Her grandmother died with high blood pressure at age 50. Her mother, though long-lived, had high blood

pressure as well. Both her father and his brother died at age 62 with heart disease. "[My doctors] sent me to a

cardiologist in my 40s," Mrs. Russell says. "I knew that I would be susceptible."

So she saw a cardiologist twice a year, used a home blood pressure monitor, and took medication for high blood pressure. But one day, her genes came knocking. "I was in my backyard, and I began to feel dizzy and started

walking wobbly. I got myself in the house and called 911. When I got to the hospital, they were able to detect what my problem was. I had an atrial fibrillation, and they think I had a little mini-stroke."

continued

1 l 2 l 3 Back to Articles