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The Truth About
Heart Disease in Women
By Dr. Robert J. Schanzer,
Cardio Medical Group, 5 Mountain
Boulevard , Warren
Almost all discussion about women's health center on breast cancer and
the need for aggressive monitoring and early diagnosis. The push to educate
women about breast cancer has been so great, that almost all women can
quote their lifetime risk of breast cancer, which is 1 in 9 women. Few
women, however, realize that cardiovascular disease is the number one
cause of death in women, outnumbering deaths from all other causes combined
and that 50% of women will die of cardiovascular disease, compared with
4% who die from breast cancer.
Despite the magnitude of this problem, women are less likely than their
male counterparts to seek medical attention or undergo a cardiac workup.
They undergo yearly mammography and visits to their gynecologist but
rarely do they undergo health maintenance to assess their cardiac risk
factors. In fact, women have been excluded from many of the early clinical
trials regarding heart disease because of the misbelief that women were
not affected by this disease. This has led to a severe gap in knowledge
regarding cardiovascular care for woman. This lack of knowledge has led
to many episodes of inaction and non treatment by physicians leading
to missed opportunities for life saving treatments.
Although many risk factors for heart disease such as diabetes, cigarette
smoking, being overweight, elevated cholesterol levels, high blood pressure
and family history are shared between men and women, the incidence and
progression of the disease varies. Premenopausal women are at a lower
cardiovascular risk than their male counterparts, but by 10 years postmenopause
the risk ratio equalizes. The only way to prevent post menopause heart
disease is by early diagnosis and treatment.
Females are more likely than males to present with atypical symptoms
of angina, such as fatigue, shortness of breath, dizziness, feeling of
anxiety, back pain or referred pain to their jaw, neck or even teeth.
Many older women are under the misconception that angina is a man's disease
and therefore delay seeking treatment. When the diagnosis of heart disease
is made and these women finally come under the care of a cardiologist,
they tend to have more advanced disease and may have fewer therapeutic
options. Epidemiologic studies have demonstrated greater mortality, as
well as increased complications in women that in men after a heart attack.
63% of women who die from their first cardiovascular event have no history
or prior symptoms.
The life expectancy for women today is 78 years of age and the average
age of a woman at menopause is 51 years of age. Given these facts, women
can expect to live 1/3 of their lives in the postmenopausal state where
they are at an increased risk of heart disease. The increased risk of
heart disease when a woman reaches menopause is believed to be secondary
to decreasing levels of estrogen. This has led to the treatment of postmenopausal
women with hormone replacement therapy to ameliorate their cardiovascular
risk. While estrogen patches improved the symptoms of menopause, they
do not show any cardiovascular benefit. Oral hormone replacement therapy
does decrease your risk for heart disease, however, a recent large scale
study of over 2,500 postmenopausal women called the Heart and Estrogen/
Progesterone Replacement Study (HERS) also demonstrated an increase risk
of Breast and Endometrial cancer. Currently, there is no consensus regarding
the role of hormone replacement therapy in the prevention of coronary
artery disease. Recommendations are evolving as new data becomes available.
Although the best therapeutic regimen to prevent heart disease in women
is still under investigation, we know that cardiovascular disease is
the number one killer in women and can be averted with aggressive risk
factor modification. Heart disease is both preventable and treatable.
As more is learned about what causes the problem it is becoming increasingly
apparent that there is much that you can do to prevent it from occurring.
Just as breast cancer awareness programs have led to the early disgnosis
and treatment of breast cancer leading to decreased female mortality
from breast cancer, we must educate women about the prevalence of heart
disease and the ways to modify their cardiovascular risk factors. In
so doing, we will hopefully reduce the prevalence of cardiovascular disease
in women and allow them to live longer and healthier lives.
WBPA - The Warren Showcase - February 2004
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