Ask a woman what disease she fears most, and most likely she will answer “breast cancer.”
But while breast cancer is a highly visible risk, heart disease is actually the leading cause of death among women of all ages. A woman is six times as likely to die from cardiovascular disease than from breast cancer.
In fact, in every year since 1984, more American women than men have died from heart disease. This startling revelation has spurred two decades of careful study of the causes, symptoms, treatments and outcomes of heart disease in women. And this means that we now have critical information for women that will help keep them out of our operating rooms and catheterization laboratories.
The media has overemphasized disparities between the sexes, creating the perception of vast differences between women and men when it comes to coronary heart disease (blockages in the heart’s arteries that can cause heart attacks). But the truth is that there are actually more similarities than differences between the sexes. Most important, women need to understand that the primary symptom of coronary heart disease, chest pain and the principal strategies for prevention and treatment—healthy lifestyle, medicine, angioplasty and surgery—apply equally to women and men.
Estrogen and cardiac protection
Unfortunately, it is all too common for women and their doctors to ignore the threat posed by heart disease. The biggest mistake they make is to place too much faith in the power of estrogen. It is true that estrogen affords premenopausal women a certain amount of protection from coronary heart disease. This is one reason that, compared to young men, young women are less likely to get heart disease.
Potentially beneficial effects of estrogen include decreased LDL cholesterol (the “bad” cholesterol), increased HDL cholesterol (the “good” cholesterol), blood vessel relaxation and protection of blood vessels from injury. Scientists believe that the combination of high circulating estrogen levels and a relatively low number of standard cardiac risk factors (smoking, high blood pressure, diabetes, high cholesterol) delay the appearance of coronary heart disease in most young women.
But everything changes at menopause. Estrogen levels drop by 90 percent and the type of estrogen in the body changes, with most of the estrogen being produced by fat cells (estrone) rather than by the ovaries (estradiol). This major hormonal shift contributes to the increased risk for coronary heart disease that begins soon after menopause. By age 65 women catch up to men, achieving an unwanted equality as they develop heart disease at a rate equal to that of men of similar age.
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