Women and Heart Disease
An interview with cardiologist, Dr. Robert Corne
LW.: I have read that heart disease surpasses any other disease as the leading cause of death amongst women.
R.C.: That fact has only been appreciated more recently. The perception among the medical community was that heart disease was uncommon in women, although, in fact, AFTER menopause, prevalence of coronary disease INCREASES.
L.W.: Why is that?
R.C.: There are several reasons:
Firstly, the symptoms of heart disease in women are often atypical and more difficult to recognize and establish a diagnosis. Women may present with a general feeling of unwell, nausea and/or arm discomfort and not with the classic symptom of central chest heaviness.
Secondly, Conventional noninvasive testing, such as a stress test (performed on a treadmill), or cardiac nuclear imaging, has a lower predictive accuracy in women, i.e. false positives.
L.W.: Is heart disease in women related to hormonal changes?
R.C.: A lot of evidence suggests that estrogen is protective and has a favorable effect on lipid (cholesterol/fat) metabolism, blood clotting parameters and the response of blood vessels to chemical and nervous stimulation. These factors, coupled with the low prevalence of coronary diagnosis in premenopausal women, led to the “Estrogen Hypothesis,” namely that estrogen treatment in post menopausal women should be cardio-protective.
Large clinical trials, such as The Women’s Health Initiative, have NOT validated that hypothesis. This is largely due to the combination of progestin with estrogen treatment in women with an intact uterus. The progestin has been added because estrogen alone can increase the risk of uterine cancer.
L.W.: What about the effects of estrogen in women who have undergone a hysterectomy?
R.C.: There is the suggestion that estrogen alone in women who have had a hysterectomy may be cardio-protective.
L.W.: What should premenopausal women do if they experience hot flashes, excessive perspiration and other unpleasant symptoms?
R.C.: Short term estrogen combined progestin treatment can be helpful in reducing these vasomotor symptoms. However, if it is elected to use estrogen ALONE in a woman who has NOT had a hysterectomy, then it is important for her gynecologist to periodically check her uterus for endometrial cancer.