Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Cardiovascular Disease

Although women worry about cancer, osteoporosis and accidents, the leading cause of death in women is cardiovascular disease. Cardiovascular disease is a term used to describe damage to blood vessels from high blood pressure, the buildup of cholesterol, etc. Once small blood vessels become compromised, vital organs no longer receive adequate blood flow with oxygen and nutrients. The end result is that the tissues cannot function optimally, or may even receive such an inadequate supply of oxygen that the organ is permanently damaged. During a heart attack, the small vessels that feed the heart become damaged, and the heart is permanently damaged from the lack of oxygen. Medically, this is called a myocardial infarction. The incidence of cardiovascular disease and heart attack (myocardial infarction) increases dramatically after menopause. This is what initially prompted a study called the Womens Health Initiative Study. Researchers believed that the increased risk of cardiovascular disease might be correlated with the decrease in hormones during menopause. Unfortunately, the relationship is apparently more complicated, as hormone replacement therapy was found to possibly increase the risk of cardiovascular disease.

Detection of possible risk factors and appropriate intervention can prevent cardiovascular disease. In the past, the majority of studies were performed on men. Now, as more women are included in medical studies, more is understood about the development of cardiovascular disease in women. In fact, the risk factors in women are somewhat different than men. These key risk factors are: high cholesterol, diabetes, smoking, and hypertension. For example, high cholesterol or dyslipidemia is a known risk factor for both men and women. In women however, low good cholesterol or HDL is more predictive of heart disease than high bad cholesterol, or LDL. Total fasting cholesterol more than 265 mg/dl and triglycerides greater than 400 mg/dl should be considered risk factors. Diabetes mellitus is also a strong predictor of risk for cardiovascular disease in women. All women with diabetes should undergo further testing for coronary artery disease. Smoking is associated with one-half of all heart attacks in women. Women who smoke only 1-2 cigarettes per day have twice the risk of developing a heart attack than non-smokers. Cessation of smoking is associated with a rapid reduction of risk. Hypertension is another important risk for cardiovascular disease. In pre-menopausal women, hypertension alone increases the risk for cardiovascular disease 10 times that for someone who has normal blood pressure. Women with a family history of a first degree male relative under 55 or a first degree female relative under 65 with coronary heart disease are at increased risk. Other important factors can help reduce the risk of cardiovascular disease. These include avoidance of obesity, sedentary lifestyle, and excess alcohol intake.

What tests should be performed? Women at high risk for cardiovascular disease should begin cholesterol and other appropriate screening as dictated by their physician at as early as age 20. All women regardless of known or perceived risk should receive cholesterol screening every 5 years by age 45. Additional laboratory and non-invasive testing may be performed for those who are at risk. The American Heart Association has guidelines to help reduce the risk or even prevent CVD. These recommendations include: regular physical activity, smoking cessation, body mass index 18.5-24.9 kg/m2, low-fat diet, treatment of high cholesterol, treatment of hypertension, and treatment of diabetes.