Women and Heart Disease

young woman painting a red heart on the wall

 By  Dr. Nik Nikam

Heart disease is a leading cause of death among women (483,842 deaths in 2003), and accounts for 32% of all deaths. Nearly 500,000 women have heart attack each year.

How are women different?
Younger women have a lower incidence of heart disease compared to men, due to the hormonal protection against arterial blockage and high HDL cholesterol levels. However, after menopause, the incidence of heart disease among women is equal to that seen in men.

Thirty percent of the women are likely die following a heart attack in the first year in comparison to 25% of the men.

Women generally have smaller coronary arteries. As a result, women are twice as likely as men to have complications following cardiac surgery.

Women have microvascular disease that involves very tiny arteries that cannot be treated with angioplasty or bypass. None the less, they cause chest pain and shortness of breath.

The treatment would include modification of risk factors to minimize the blockages in the small arteries.

Birth control pills can increase the risk of heart disease and stroke, especially in women with high blood pressure, diabetes and other risk factors.

There is lack of relative knowledge among physicians regarding the magnitude and the seriousness of heart disease among women. As a result, often, women are under-treated.

History: Most women do not have a classical exertion related chest pain. There is also a tendency in the medical field to attribute their symptoms to gastrointestinal problems such as gall stones, peptic ulcer, or stress. However, as an educated consumer, you want to ask your doctor to evaluate you for the heart disease risk factors and recommend tests to rule out heart disease.

Risk factors: The risk factors are cholesterol, diabetes, smo-king, overweight, hypertension, and sedentary lifestyle.

Cholesterol: Cholesterol is the number one risk factor for heart disease both in men and women. The total cholesterol should be less than 200 mg or less than 160 mg in patients with diabetes. The LDL or the bad cholesterol must be close to 70 mg to 80 mg. The HDL or the good cholesterol is usually high in younger women. It should be more than 40 mg.

Triglycerides: Elevated tri-glycerides are considered an independent risk factor for heart disease among women. Elevated triglycerides are commonly seen in association with diabetes. When diabetes is controlled, the triglyceride levels come down. Other conditions that lead to elevated triglycerides would include excess carbohydrate or fatty diets and alcohol.

Smoking: Smoking doubles the risk of heart disease. The risk of heart disease drops by 50% percent after one year of quitting smoking.
Blood pressure: The normal blood pressure is 120/80 mmHg. You can reduce your blood pressure with salt restriction, weight control, and exercise before you need any medicines.

Overweight: It also can increase the risk of heart disease. It increases the risk of high blood pressure, diabetes, elevated cholesterol, and triglyceride levels. Weight control reduces most of the above mentioned risk factors. Keep you BMI below 25.

Diabetes: It is considered a very strong risk factor for heart disease. Strict control of diabetes can delay the rate at which most complications progress, including the development of heart disease symptoms.

Non invasive studies:

Electrocardiograms are of limited value in accurately diagnosing heart disease

Even regular treadmill stress test is not very helpful in excluding the heart disease, since 50% of the results can be false positive.

Nuclear stress test is more accurate in the diagnosis of heart disease. It also has limitations. Most women may not be able to reach the desired target heart rate during exercise. Additionally, the breast shadows may create artifacts interfering with the proper interpretation of the scans.

Positron Emission Tomo-graphy (PET) may be useful in detecting microvascular disease.

CT angiography is a noninvasive study that can detect coronary artery disease with a 98% specificity. That means, if the CT angiography is normal, the chances of having significant coronary artery disease is less than 2%.

The ultimate approach would be cardiac catheterization which is considered the gold standard.

Treatment: American Heart Association recommends that women with heart disease should receive aspirin (165 mg), beta blockers, ACE inhibitors, in addition to cholesterol lowering drugs, multivitamins, and mineral therapy.

Hormone therapy has not been shown to reduce the incidence of heart disease. If hormones are primarily used for control of post menopausal symptoms, your physician may consider a lower dose hormone for the shortest possible duration.

Routine use of folic acid has not been shown to reduce the incidence of cardiovascular events.

Nikam’s Diet
Keep calorie intake to 1200- 1500 calories. Cut carbs.
Reduce fat intake to less than 30% of total calories.
Saturated fat should be less than 10% of total calories
Lean meat intake should be less than 8 ounce/day.
Exercise 20 to 30 min, 3-4 time per week
Use skim milk and vegetables
Consider Omega-3 such as fish oil or Flax seeds/oil supplements
Fish: Salmon, mackerel, tuna 2-3 servings per week
A glass of red wine per day
Watch comedy channel
Quit smoking
Drink 8 glasses of water per day
Grilled meat in place of gravies
Niacin 500 to 1000 mg /day
Avoid egg yolk, organ meat, solid fats, canned foods
Salt intake less than 1 tsp/d

Useful websites for more information on heart disease among women are:

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Nik Nikam, M.D.
P: 281-265-7567