Cardiovascular heart disease (CVD) is the number one killer in women over age 65 and the second leading cause of death among women ages 45 to 64. More women die from cardiovascular disease than all other causes of deaths such as lung cancer, breast cancer, stroke and COPD (chronic obstructive pulmonary disease) combined. So, it’s a critical issue in health care today, and every woman needs to be aware of that.
Menopause seems to play and important role in CVD because of lower levels of estrogen. Women who go prematurely go through menopause at a younger age have an even higher rate of heart disease. New studies such as the KEEPS (Kronos Early Estrogen Prevention Study) are showing that if estrogen is started within a few years after the beginning of menopause, there is not an increase in the risk of heart attack or stroke.
When the subject of heart attack is discussed, most women think of crushing chest pain or pain that radiates down the left arm. But women tend to present with atypical symptoms when they’re having a heart attack. They are more likely to feel profound fatigue, shortness of breath, and less than half of them will have the classic chest pain. That’s why many women don’t realize they are having a heart attack, and even if they go to the emergency room, the diagnosis is sometimes missed.
Traditional risk factors for CVD include high cholesterol, high blood pressure, diabetes, sedentary lifestyle, and poor diet. Additional risk factors for CVD in women include autoimmune disorders such as lupus and rheumatoid arthritis, and pregnancy-related disorders such as gestational diabetes, pregnancy-induced hypertension and preeclampsia. Women who have any of these things are at more risk of having heart disease and even heart attack.
What makes diagnosing heart disease in women so challenging is that the usual tests do not apply for women. For example, in men, CVD is diagnosed by doing an angiogram test in which a small catheter is placed through a vein and thread into the heart arteries where a small amount of a dye is injected to see if the big arteries are blocked. If there is a blockage, a stent can be used to open the blockage.
Over 50% of women who get a catheterization will have no blockage found, but they still have persistent chest pain and persistent symptoms. They are then falsely reassured that they don’t have heart disease. However, the fact is that they do have heart disease, but instead of the larger heart arteries being affected, the disease is in the small arteries of the heart. This is called microvascular disease or microvascular dysfunction. It puts them at a higher risk for a heart attack even though the larger arteries are open.
So when there are persistent symptoms like chest pain, shortness of breath, extreme fatigue or back or jaw pain with exertion, women should tell their medical provider, and the provider should consider ordering tests that may include an exercise treadmill test and possibly other tests such as a stress echo test (that uses ultrasound to test the heart while you are on a treadmill), a Single Photon Emission Computed Tomography (SPECT) scan, which is a nuclear imaging test that shows how blood flows to the heart, an MRI or a Positron Emission Tomography or PET scan that injects a small amount of radioactive material into a vein to look for abnormal blood flow.
Remember, even if your large cardiac arteries are open, if you continue to have symptoms, microvascular and/or endothelial dysfunction should be considered and tested for.
Until next time,
Dr. Mache Seibel, Founder of My Menopause Magazine http://bit.ly/MyMenoMag
Professor, University of Massachusetts Medical School
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