Healthy Spirit E-Module #16

WOMEN AND HEART DISEASE

Except for World War I, heart disease has been the leading cause of death in the United States since 1900 while killing one in four women. Although men on average develop heart disease ten years earlier than women, more women die of the disease primarily because it is most prevalent in the latter decades of life. In fact, nearly twice as many women die of cardiovascular disease than all forms of cancer.

Gender Issues
Unfortunately, even today heart disease is diagnosed and treated less aggressively in women than in men. Although risk factors for heart disease are similar in both genders, women often exhibit slightly different symptoms. For example, women may not experience the crushing chest pain often describe by men. S ymptoms such as breathlessness, fatigue, and nausea reported by women with heart disease are subtler than those reported by men. Occasionally, physicians even mistake chest pain complaints in women as anxiety attacks.

Women have smaller hearts, weighing 50 to 100 grams less than men's. Their hearts also beat faster, and their arteries are more thin and fragile. As a result, women can also suffer more complications pre- and post-heart surgery due to smaller blood vessels. In addition, diagnosing heart disease in women via the graded treadmill test can sometimes be unreliable as well.

The female hormone estrogen present during a woman's menstruating years exerts a protects against heart disease, rheumatoid arthritis, and other auto-immune and degenerative diseases. Estrogen promotes increased levels of HDL-cholesterol (good cholesterol), thus levels are higher in women than men. In addition, LDL (bad cholesterol) levels are also low for women who have adequate estrogen levels.

However, following the onset of menopause estrogen production decreases. After about age 60, women are at as much risk as men, if not more so, to experience heart problems. Other risk factor issues remain inconsistent between genders as well. Women who smoke suffer heart attacks fifteen years earlier than those who don't on average, while male smokers typically experience them seven years earlier. Furthermore, diabetes has shown to be a much stronger cardiovascular risk factor for women, contributing to as many as one in five post- menopausal heart attacks.

How can women improve their care?

• Be proactive: Recognize your risk and be alert to the symptoms of heart disease.
• Schedule an annual physical with a thorough screening for heart disease risk factors by a doctor who is familiar with the disease (one that's board certified in internal medicine or family practice). The physical should contain:
  
  - A complete blood work up (cholesterol broken down into HDL, LDL and triglycerides)
  
  - A resting electrocardiogram (analyzes the heart's electrical activity)
  
• Put in place specific steps for lowering your cardiac risk profile including exercise, other lifestyle changes, and pharmaceutical alternatives such as cholesterol-lowering drugs.
• Ask your physician about hormone replacement therapy (HRT). HRT is not always the best alternative however, and may actually increase your risk of heart disease.

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