“Women and Heart Disease” (Published February 24, 2000)

If women are asked what disease they most fear, the answer is usually breast cancer. However, for many years it has been known that coronary artery disease, the same affliction that kills most men, is also the number one killer of women in America. In fact, heart disease kills more women each year than men. Thus the concern that there is a sudden epidemic in heart disease in women simply reflects the popular misconception that women are at lower risk of coronary heart disease than men.

Certainly the risks factors for premature heart disease in women are somewhat different than for men. The benefits of estrogen protect women for most of their lives. Estrogen seems to blunt the effects of traditional risk factors like elevated cholesterol and high blood pressure. After menopause and the attendant changes in hormone levels, women may have acceleration in the progression of heart disease so that within fifteen to twenty years, cardiovascular risks match that of age-matched men. The use of hormone replacement therapy may blunt the effects of menopause, but there may be other concerns that may suggest that hormones after menopause should be carefully discussed with the woman's doctor first. By the way, although hormones have been shown to protect women from heart disease, the use of estrogens in men was attempted in the 1960s. The result was a higher death rate in those men on estrogen, confirming that men are different than women!

Uncontrolled diabetes is another risk factor that takes away the woman's inherent hormonal advantages. Diabetic women and men also tend to have more severe disease than their non-diabetic peers, and diabetic patients do less well after heart attacks and heart bypass than non-diabetics. In addition, active cigarette smoking also contributes significantly to a woman's risk of premature coronary disease.

But there are very interesting data that have emerged from recent clinical trials of medications designed to test whether or not drugs can change the course of premature or high risk coronary heart disease. The use of cholesterol lowering medications known as statins has shown that women benefit even more from drug therapy than men. This is true whether someone has actually had heart disease or not.

Despite popular misconception, women are at the same overall risk for heart disease as men. But women benefit more from drug interventions than men. By recognizing these facts and obtaining the right information, women and men can reduce their risk.


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