Editor’s Note: This is the final in a two-part series that began last week. Part one, which ran Feb. 3, discussed the emerging understanding that the cardiovascular system of men and women are different due to the effects of sex hormones (especially estrogen in women).
In today’s installment, I discuss emerging new trends in assessing and then treating heart disease in women. Remember that the heart has its own supply of blood and oxygen by way of arteries that lie on the surface of the heart. These arteries vary in size from the larger ones that branch off the aorta to very small in size. Researchers are not sure why, but women are more likely than men to develop heart disease involving these small vessels. The reason may be linked to a woman’s decreased estrogen levels at the onset of menopause (that time in a woman’s life when the ovaries begin to slow down their production of estrogen).
Generally speaking, in men the larger heart vessels become narrowed or blocked because of atherosclerosis and “hard plaques” where fatty deposits build up leading to decreased blood flow to the heart muscle causing the crushing pressure-type of chest pain known as angina. Women, on the other hand, may be developing atherosclerosis as they go through menopause but their angina is more likely to be vague and felt as fatigue, nausea and/or dizziness because the smaller vessels become blocked before the larger ones; a women’s symptom complex of heart pain can frequently be less dramatic and, therefore, draw less attention and less urgency. When women seek care, their providers may be misled by the symptoms and a diagnosis of heart disease may be missed. In fact, a large proportion of women who have a first heart attack would say they never had any warning symptoms.
So, what are women to do?
Women need to realize that they, unlike previous generations of women, will have many more years ahead of them living without the protective effects of estrogen. This situation added to the existence in some women of abnormally elevated cholesterol really puts them at risk. Women, especially post-menopausal and perhaps even peri- or early menopausal, need to be pro-active and make sure that a cardiac work-up is considered if they experience vague symptoms that don’t add up to another diagnosis or respond to other therapies. The vague symptoms of “dis-ease” may actually be your signature cluster of cardiac symptoms.
Whereas the Framingham Risk Factor analysis is an excellent tool for estimating the risk of a heart attack in men, it falls short in accuracy for women. A newer tool is the Reynolds Risk Score that includes parameters to increase accuracy for women. It is a simple questionnaire but it substantially improves the ability to predict cardiovascular risk in women, so much so that if used consistently, 20 percent to 25 percent more women at higher risk for heart disease could be identified early and then offered preventive therapies.
In addition to the Reynolds Risk Score, the standard angiogram may not be a sufficient diagnostic tool for women who experience chest pain. Instead, the Calcium Heart Scan may provide more useful information for women as it identifies “soft plaques” of atherosclerosis in the smaller vessels. Those plaques are more vulnerable to rupture and blockage of a vessel. The Heart Scan is a simple, non-invasive, affordable screening test for women to consider if they are deemed to be at risk for heart disease.
Treatment for “small vessel” disease includes much of the standard heart disease therapies with some additional modalities; but open-heart surgery is not one of them. The bottom line is for women to start taking care of themselves as well as taking care of their families; partaking in a healthy diet, making time for aerobic exercise several times a week, learning how to deal with life’s stresses, making time to get adequate rest/sleep and getting regular check-ups.
As always, questions and comments are welcome.
Agnes Oblas is a nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call her at (602) 405-6320 or e-mail her at firstname.lastname@example.org. Her Web site is www.newpathshealth.com.