WOMEN AND ARTERIOSCLEROSIS
W. G. Franklin, M.D.
The risk of heart attack and stroke is relatively low in women until menses ceases at menopause or following hysterectomy. Then the risk rises abruptly, coinciding with an abrupt rise in iron levels. Iron is an oxidant that catalyzes the oxidation of the bad cholesterol, LDL, to a form that builds up in the walls of arteries. The risk of heart attack (MI) is reduced up to 85% by donating blood every 4 months. Avoidance of iron in vitamin supplements and foods also helps.
Recent studies indicate that hormone replacement therapy may slightly increase the risk of heart attack in the first two years after the start of treatment. This is postulated to be related to an increase risk of blood clotting and could possibly be negated by taking aspirin 81 mg daily. After the first two years, hormone replacement actually reduces the risk of heart attack but it is much less effective than aspirin, beta blockers, ACE inhibitors, or cholesterol lowering STATINS. Prescribing hormone replacement is useful for prevention of menopausal symptoms, improving a feeling of well being, and prevention of osteoporosis. If a fast CT scan indicates an absence of arteriosclerosis, then the risk of heart attack is exceedingly low and hormone replacement therapy would be relatively safe.
Smoking dramatically raises the risk of heart attack. Smoking one pack per day for 10 years increases the rate by 10 fold, 20 years by 20 fold, etc. Smoking and birth control pills (BCP) together can double these numbers. Some Gynecologists decline to prescribe BCP to patients who continue to smoke.
A fast CT scan of the heart (EBCT) is a 45 second test that detects calcium (hardening) of the coronary arteries. Calcium is a marker of arteriosclerosis. The test is generally 99% accurate after the age of 30. For unknown reasons, women's plaques (blockages) do not calcify as much as men's. Hence, the test is slightly less sensitive in women. A stress test would be advisable if clinically indicated as an additional fail-safe test for significant coronary artery obstructions. A repeat fast CT scan should be performed after 5 years. If there is no calcium, then the disease arteriosclerosis is unlikely to be present or to develop to a significant degree.
When women have significant coronary artery obstructions, they as a group have a somewhat greater chance of having no symptoms or having atypical symptoms such as pain in the back under the wing bone. The population as a whole, however, has no significant symptoms at all in 80% of people until the day their heart attack or sudden death. Consequently, most people regardless of gender do not have warning symptoms.
Women have slightly poorer results from angioplasty (PTCA) and coronary artery bypass surgery (CABG). This is a result of having smaller arteries that are more difficult to keep open post PTCA and upon which to operate. The overall results are nonetheless very good and improving every year.
30% of heart attacks occur in people whose cholesterol is below 180. The good cholesterol (HDL) needs to be above 55 in women and above 40 in a man. Hormone replacement therapy, regular exercise 20 minutes 5 times per week, and wine or beer 4 times per week all raise the HDL. Vitamin B3, Niacin, in delayed form is available without prescription and is very effective in raising the HDL. It is the only agent known to lower lipoprotein A, a harmful protein carrier of cholesterol.
The leading cause of death in women over the age of 55 is heart attack. The second leading cause of death is stroke. There are a total of 500,000 strokes per year. 40% of these are in women. That's 200,000. Of the 150,000 fatal strokes, 60,000 occur in women. In comparison, breast cancer results in 50,000 deaths per year.
Strokes are attributed to arteriosclerosis 80% of the time. The remaining 20% result from hemorrhages (bleeding) in the brain. Prevention of stroke involves modification of risk factors such as smoking, hypertension, diabetes, and abnormal lipid levels.
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Smoking is estimated to cause 12% of strokes.
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Reducing the systolic BP by 10 mm or the diastolic BP by 5 mm reduces the risk of stroke by 40%.
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Although one alcoholic beverage 4 times per week (beer or wine) has been demonstrated to reduce the risk of heart attack, more than 2 alcoholic beverages per day result in an increased risk of hemorrhagic stroke. Moderation is advisable.
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Obesity is associated with higher blood pressure, higher cholesterol levels, higher sugar and insulin levels. Obesity accounts for 15-25% of strokes.
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Regular moderate exercise decreases the tendency of blood to clot (platelet aggregability), increases HDL (good cholesterol), lowers BP, elevates endorphin levels, regulates heart rate and rhythm, and counteracts depression.