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:
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Women who were obese and sedentary were 3.5 times as likely
to have heart disease.
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Obese women who exercised regularly were 2.5 times as
likely to develop heart disease.
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Women who were not overweight but did not exercise had
about 1.5 times the risk.
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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%.
