Cardiovascular Disease: The Silent Killer of Women
I’m teaming up with Dr. Contreras (Family Medicine Physician) @coachecuadoc to discuss this important topic!
Cardiovascular disease (CVD) is the leading cause of death in women. Though there has been an overall decline in CVD mortality over the past 40 years, the mortality in younger women has plateaued since around the year 2000. The incidence of myocardial infarction (MI) in women, although lower than in men, increases dramatically following menopause. The increase is at least in part due to increasing age since men also have a progressive increase in MI with age. The role of menopause itself is not so clear.
-What is cardiovascular disease?
Cardiovascular disease (CVD) includes four major areas:
●Coronary heart disease (CHD) clinically manifested by myocardial infarction (MI), angina or chest pain, heart failure, and coronary death
●Cerebrovascular disease clinically manifested by stroke and transient ischemic attack
●Peripheral artery disease clinically manifested by intermittent claudication
●Aortic atherosclerosis and thoracic or abdominal aortic aneurysm
What are cardiovascular risk factors for women?
●Personal history of CHD or other atherosclerotic vascular disease (peripheral arterial, cerebrovascular, and aortic disease)
●Age over 55
●Family history of premature CHD (first-degree male relative under age 50 or a female under age 60)
●Hypertension
●Dyslipidemia – High low-density lipoprotein (LDL) and/or low high-density lipoprotein (HDL)
●Diabetes mellitus
●Metabolic syndrome
●Chronic kidney disease (CKD)
●Smoking
●Post-menopausal status
●Psychological stress (eg, depression, posttraumatic stress disorder)
●Inflammatory/rheumatic diseases
●Pregnancy-related complications (eg, eclampsia, preeclampsia, gestational hypertension, gestational diabetes)
Elevated triglycerides, obesity, and a sedentary lifestyle, while not considered primary risk factors in the National Cholesterol Education Program (NCEP) guidelines, are also associated with coronary risk. These cardiovascular risk factors are more frequent among ethnic minority women such as Latinas and African Americans, than among white women.
Does the age of your first period or age of menopause play a role?
Early menarche or age of your first period appears to be associated with future CHD. The younger you get your first period, the higher your risk can be based on studies.
CVD is unusual in premenopausal women, particularly in the absence of other risk factors but being in menopause itself does not increase your risk alone, it is more due to older age. Still, studies do show that women who go into an early menopause have a higher risk.
Does hormone therapy at menopause decrease your risk of CVD?
It is not clear by what mechanism menopause may increase CVD risk, but hormone replacement does not appear to be protective. In a few important studies hormones will not improve or risk and may even be harmful. t
What is my risk if I have had a hysterectomy?
The possible role of hysterectomy as a predictor of cardiovascular risk was assessed in a report from the WHI Observational Study of almost 90,000 postmenopausal women, approximately 40 percent of whom had undergone hysterectomy with or without oophorectomy. Hysterectomy with or without oophorectomy was not associated with a significant increase in total mortality or fatal and nonfatal CVD.
Is my risk higher if I have PCOS?
The presence of obesity, insulin resistance, impaired glucose tolerance (IGT) or type 2 diabetes, and dyslipidemia may predispose women with polycystic ovary syndrome (PCOS) to CHD. However, an excess risk of CHD in women with PCOS is not well established.
If I had certain pregnancy complications will that increase my risk in the future?
Women who develop preeclampsia during pregnancy have a twofold or greater risk of developing CVD later in life.
A similar risk for future CVD is seen in those women with gestational diabetes.
Women with a history of spontaneous pregnancy loss, but not induced abortion, have been shown to have a higher risk of MI later in life. While the exact nature of this risk is not fully known, it may relate to procoagulant and proinflammatory states that are associated with recurrent miscarriages.
Also, women who have a spontaneous delivery prior to 37 weeks of gestation appear to have an increased risk of CVD when compared with women who deliver at term and pacental abruption also appears to be associated with an increased risk of CVD.
Hope this information helps ladies!! Take care of your heart!
Dr. Erica
“Your health is all you got. Do something about it before you can’t!”