Arterial Disease

Some Topics

  • Men and Women Differences in Cardiovascular Disease

    One of the medical scandals of the 20th century was the neglect of women in studies of cardiovascular disease. For many years, heart attacks were considered to be a men's problem and only men were included in studies of blood fats, drugs for cholesterol and high blood pressure management. According to US stats from 2003, 6 million American women had heart disease, 3 million had strokes, and half a million women died of cardiovascular disease -- more deaths than were attributed to the other leading causes of death combined.

    There are a host of gender differences in the patterns of disease, symptoms and response to treatments. Men tend to have better results from bypass surgery, and recover better from heart attacks. Risk factors remain the same for men and women. The response to drugs is another matter and differences are recognized but not well managed. Compared with women who exercised regularly and were not overweight, Hu et al reported that:

    • Women who were obese and sedentary were 3.5 times as likely to have heart disease.

    • Obese women who exercised regularly were 2.5 times as likely to develop heart disease.

    • Women who were not overweight but did not exercise had about 1.5 times the risk.

    • Cigarette smokers who were obese and sedentary were nine times as likely as active, normal-weight nonsmokers to develop heart disease.

    It was known that women had fewer heart attacks than men during their reproductive years and it was widely believed that estrogen in combination with progesterone protected younger women. After menopause, the incidence of heart attacks and strokes increased rapidly in women and heart attacks were the leading cause of female deaths. For many years, estrogen and then estrogen plus progesterone were prescribed to postmenopausal women with the hope of preventing arterial disease.

    The surprising news from the Women's Health Initiative study in 2002 was that older post-menopausal women taking combined estrogen and progesterone actually had increased risk of heart attacks and strokes. Not everyone agrees with the study conclusions, but the news changed medical practice almost overnight. Many studies have demonstrated that estrogen improves cholesterol levels, relaxes blood vessels and increases blood flow, but in older women, it also increases clotting and promotes inflammation. The net effect of estrogen will depend on how much of which estrogen you take and at what age you take it.

    Another bit of shocking news from a Yale study, was that taking a popular heart drug, digoxin (digitalis), to slow heart rate and treat congestive heart failure actually increased the risk of death in women by 23%.

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