Women’s Heart Health
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We provide exceptional care for all of our patients, male and female. But as we well know, men and women are different — and those differences also apply to heart health and heart disease. At Cooper and Inspira Cardiac Care, we pay special attention to the unique heart health issues faced by women.
Identifying Risk Factors for Women
The risk factors for heart disease for men and women are similar. When we determine whether someone has a higher risk of heart disease, we consider many factors: blood pressure, cholesterol, level, diabetes, weight, smoking, and any family history of premature coronary artery disease. Those risk factors are the same, but some are more important for women.
We have learned to look at the risk of heart disease over a woman’s lifetime. For instance, women who have pregnancy-induced hypertension may be more likely to have hypertension when they get older. A woman who has gestational diabetes when she’s pregnant is more likely to have diabetes later. Our goal is to intervene before a condition develops that can lead to a greater risk of heart disease.
We advise our female patients that they are “protected” by estrogen until the time of menopause, usually between the ages of 50 and 60. That’s because estrogen helps to keep a check on certain risk factors. For example, when estrogen levels decline, levels of LDL (the bad cholesterol) increase and levels of HDL (the good cholesterol) decrease. That can lead to the buildup of cholesterol and plaque in the arteries and contribute to heart attack and stroke.
With the onset of menopause, women catch up with men in terms of heart attacks, and then surpass them. On average, cardiovascular disease develops 7 to 10 years later in women than in men. Some risk factors become more pronounced for women as they age.
Some of the increase in heart disease in women has to do with postmenopausal weight gain. The reason we consider being overweight a risk factor for coronary disease is that weight gain leads to higher blood pressure and bad cholesterol levels and increases the risk of diabetes. We see more diabetes in women, and this is a more potent risk factor for women than for men. Elevated triglycerides, also a part of the menopausal lipid shift, may be a stronger predictor of women’s heart attack and stroke. When women are finally diagnosed with heart disease, they usually have more risk factors and advanced disease, with a poorer prognosis.
We know that if we identify factors that may contribute to having a heart attack or stroke, we can intervene early. We encourage patients to pay attention to their weight and get their cholesterol and blood sugar levels under control with changes in diet and lifestyle. If necessary, we will prescribe medications for blood pressure or high cholesterol. We always work with the patient to reduce the risk of a heart event, with prevention as our primary objective.
Many women gain weight after menopause and are more likely to develop diabetes which makes women more prone to have a heart attack as they reach menopause.
Understanding a Woman’s Heart
At Cooper and Inspira, we are dedicated female and male cardiologists. Our physicians focus on a woman’s unique cardiac problems. All of us began as general cardiologists. Some of us have advanced training in heart arrhythmias, such as atrial fibrillation, ventricular tachycardia, and placement of pacemakers and defibrillators. Some have interest and additional training in advanced structural heart disease, including TAVR (transcatheter aortic valve replacement), placement of left atrial appendage occlusion devices for atrial fibrillation, and mitral clip placement as a nonoperative alternative to mitral valve replacement. We share a cardio-oncology program with oncologists at MD Anderson at Cooper, if therapy may contribute to heart disease. We also work closely with our obstetrics-gynecology colleagues, collaborating on high-risk pregnancies.
We are a university-based teaching institution focused on evidence-based medical therapies. We have a commitment to lifelong learning. We openly discuss advances in therapeutic approaches to treat heart disease, and we attend and present at national and international scientific meetings. We work closely with our colleagues for better outcomes, and we adapt our practice as scientific evidence changes. We’ve also learned how to best educate you — our patient — on these advances.
Women present differently than men and often have more symptoms. They may have GI discomfort, chest pains, or persistent pain that goes to their back. So often times, a heart attack might get missed.
Kathleen Heintz, DO
Diagnosing and Treating Women and Heart Disease
An important factor we look for is a family history of an early heart attack or stroke. This means a close family member with cardiovascular disease in the 40s for men or in the 50s for women. A family history of early cardiovascular disease increases the risk of having a heart attack or stroke. For these patients, we encourage blood work to check lipid levels. We also get a baseline A1c to assess for diabetes. We encourage our patients to check their blood pressure on a regular basis.
Some of our studies show that high triglycerides, a breakdown product of cholesterol, along with an elevated LDL level, may be a more important predictor of heart attack in women. Triglycerides are very responsive to diet and exercise. A diet relatively low in refined carbohydrates, combined with regular exercise, can significantly lower triglycerides. Conversely, excessive alcohol intake can raise triglycerides. Patients who are unable to reach a reasonable triglyceride goal may be a candidate for medication to reduce their risk of heart attack or stroke. Based on evidence from cholesterol studies done over the past 100 years, we know that if we can get LDL into the range of 70 to 80 (mg/dL), we can decrease the chance of a heart attack or stroke by approximately 25 to 30 percent within five years. It’s a risk that goes down and stays down if we keep the LDL number low.
One thing we see in women, considerably more often than in men, is lupus or mixed connective tissue disease. Lupus is a chronic autoimmune disease that occurs 10 times more frequently in women than in men. It is considered a chronic inflammatory condition, and patients may experience more frequent heart problems, including heart valve disease, pericardial effusion (fluid around the heart), and heart attack. When a woman has an early heart attack that we can’t explain by other risk factors, we often look for lupus or another mixed connective tissue disease.
Early heart attacks in women and men without identifiable risk factors may result from other genetic factors. For example, there is a highly atherosclerotic (a disease where plaque builds up in your arteries) type of cholesterol called lipoprotein (a) that isn’t detected with routine blood work. We would assess for this if other risk factors are not identified. Additionally, we may assess for underlying blood diseases that may suggest an underlying hypercoagulable state that is contributing to blood clotting and early unexplained heart attack.
Depending on the risk factors, we may consider additional testing. A stress test can evaluate for narrowing of the arteries that supply the heart muscle. A baseline echocardiogram will evaluate the heart valves and the heart muscle and look for possible fluid around the heart. A coronary calcium score may help to predict plaque buildup. A cardiac MRI can help to confirm a diagnosis suggested by some of these studies. Cardiac catheterization is still our gold standard test to evaluate for plaque buildup in the small coronary arteries that supply the heart muscle. Medications or interventions, such as cardiac stenting or coronary artery bypass surgery (CABG), may be indicated.
If you’re able to exercise on a regular basis, you’re less likely to develop diabetes, high blood pressure or need medications for cholesterol.
Preventing Cardiac Disease
When women address medical conditions at an earlier age, they reduce their risk of heart attack or stroke. Losing weight and reducing blood pressure, cholesterol, and blood sugar levels can help to prevent coronary disease.
Women need to pay special attention to their cardiac health. According to one study from the American Heart Association, 64 percent of women who died suddenly of coronary heart disease had no previous symptoms.
At Cooper and Inspira Cardiac Care, we are here to help maintain healthy hearts in women (and men, too!) and to treat hearts that require our experience and special skills. Most importantly, we’ve learned that prevention is the best treatment of all.