Women and Heart Disease
Dr. Robert Corne received his medical degree from The University of Manitoba. He was a resident in Internal Medicine and Cardiology at The Mayo Clinic and completed his cardiology training at UC San Fransisco.
Dr. Corne was a professor of Medicine at The University of Manitoba, and a Cardiologist at The Health Sciences in Winnipeg, with a special interest in Nuclear Cardiology.
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, the 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 postmenopausal 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.
LW: Let’s talk about Cholesterol. What is it?
R.C.: Cholesterol is a waxy substance that is present in every cell in the body. It is carried in the bloodstream attached to proteins. This combination is called a Lipoprotein. There are several types of Lipoproteins such as
LDL and HDL. LDL or low-density lipoproteins are considered bad cholesterol. Accumulation of LDL in the damaged wall of the artery contributes to plaque formation. Plaques develop over time, long before there are any symptoms of heart disease. This can begin as early as late childhood or early adolescence.
L.W.: Why is plaque considered to be dangerous?
R.C.: Plaques can restrict blood flow to the heart muscle, causing chest pain or angina, and may rupture, triggering a blood clot that could cause a heart attack.
L.C.: What is HDL?
R.C.: HDL or high-density lipoprotein is considered good cholesterol. HDL particles transport cholesterol back to the liver where it is metabolized.
L.C.: What is a statin? And why is it prescribed for high cholesterol?
R.C.: A Statin is a drug that blocks an enzyme that is necessary for your body to make LDL.
L.C.: What are the sources of cholesterol?
R.C.: There are two sources of cholesterol. Diet is one source; that includes dairy, such as butter and high-fat cheeses, as well as meat.
The predominant source of cholesterol is manufactured by the liver.
L.C.: How should one assess the significance of the overall number for cholesterol?
R.C.: There are a number of considerations when establishing a management strategy for high cholesterol. These include the patient’s age, whether or not they have had heart or vascular disease poor diet, smoking, diabetes, or high blood pressure. These latter factors can damage the lining of the arterial wall and subsequent accumulation of cholesterol, leading to plaque buildup.
L.C.: How do you treat high cholesterol?
R.C.: The first line of treatment should be a healthy lifestyle: diet, exercise, control of the risk factors mentioned above, and if appropriate a statin. A statin is a medication that blocks the enzyme that is necessary for your body to make LDL, the bad cholesterol.
Thank you, Dad!