During the perimenopausal and postmenopausal years, it is easy to
focus primarily on gynecologic issues. But they are only a small part of
the entire picture. Heart disease for women is a major area that also
needs our focus. Dr. Maribel Hernandez outlines the importance of
evaluating risk factors. She promotes the knowledge and implementation
of good health habits as well. — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You Program
Heart disease is a significant concern for postmenopausal women. More
postmenopausal women die from heart attacks than from any other cause.
More women die from heart disease than from all cancers combined. Heart
attacks also kill more women than they do men. In addition, the symptoms
of a heart attack are different in women than they are in men. Women
need to recognize the risk factors and avoid them, including
cholesterol, diabetes, hypertension, and cigarette smoking. Genetics and
aging are other contributors. Annual exams that include cholesterol and
blood pressure screenings are a critical component in a postmenopausal
woman's cardiac health.
Symptoms of Heart Attack in Women
Many people associate chest pain with the onset of a heart attack. Chest
pain is a common symptom in men, but the symptoms of heart attack in
women may be different from the classic symtpoms of heart attack in men.
They can include:
shortness of breath while performing a normal daily activity
a persistently sharp pain in the chest, shoulder, or upper back
abdominal discomfort, sugh as nausea and indigestion
If such symptoms continue for more than an hour, a woman must be checked
immediately. If a woman is not seen within the first few hours of such
symptoms, it can be too late for her to get the maximum benefit from
interventions to stop and treat the heart attack.
Postmenopausal women are at the greatest risk for heart attacks. Besides
aging, the following risk factors are involved:
high blood pressure
lack of exercise
Women with diabetes have a two to three times higher risk of heart
attack than women without diabetes. There is good news, though. Women
can control most of these risk factors (except for genetics) through
various means, such as diet, exercise, medications, and smoking
cessation. An example of a risk factor from genetics would be family
history of somone dying of premtaure heart disease (before age 50).
Screening and Preventative Procedures
Annual routine physicals are recommended, with lipid panel tests for
cholesterol, blood tests to detect diabetes and homocystine level, and
blood pressure monitoring. Cholesterol level is measured as LDL and HDL.
The LDL is the "bad" cholesterol, which builds up in the arteries. HDL
is the "good" cholesterol in that it helps the body to remove the bad
cholesterol. If no other risk factors are involved, a woman's LDL should
be less than 130 and her HDL greater than 50. Blood pressure should not
be higher than 120/80. This is a change in the guidelines, which used to
recommend 140/90 as the upper limit.
Lifestyle modification, including diet and regular exercise, is one of
the most important tools to prevent heart diesase. Thirty minutes of
daily exercise, such as brisk walking, is enough to reduce the risk of
heart disease. The American Heart Association recommends a low-fat diet
to assist in keeping these risk factors under control.
A new screening option is to test the level of C-reactive protein, or
CPR. The liver produces this protein as a result of acute inflammation.
If the CRP level is found to be elevated, it could indicate risk for
heart attack, especially in conjunction with high blood pressure.
Hormone replacement therapy (HRT) drugs used to be recommended as a
preventative to heart disease. But the most recent studies have shown
that they are acutally ineffective in thwarting heart diesase and should
not be used for that purpose.
Postmenopausal women with risk factors for heart disease may need to
undergo a stress test to diagnose heart disease. The regular stress test
is not accurate in women; therefore, a stress test with a heart-imaging
modality, such as echocardiogram or nuclear imaging, is recommended.
Options for treatment include medications, catheter interventions (such
as coronary angioplasty and stents), and heart surgery. The treatment
depends on the severity of the heart disease and other health problems
that the woman may have. It is very important to seek medical attention
immediately at the onset of symptoms of a heart attack to receive the
optimal therapy. Heart muscle damage for a heart attack can be prevented
if treated within the first hours of the heart attack.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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