Women and Heart Disease: An Equal Opportunity Killer

In recent years, medical science has focused much attention on the particular impact of heart disease on women. Historically, heart disease was thought of as a predominantly male disease. Today, heart disease has become an equal opportunity killer.

Every year 103,000 women in the UK suffer heart attacks. Heart disease and disease of the blood vessels together claim nearly twice as many women’s lives as all forms of cancer. Yet, in general, women don't believe they'll get coronary heart disease - they tend to see it as a disease for men.

Why are women at increased risk of heart disease as they age?
The menopause is a normal stage in a woman's life; it comprises any of the changes a woman experiences either before or after she stops menstruating. As the menopause nears, the ovaries gradually produce less oestrogen (a female hormone), causing changes in the menstrual cycle and other physical changes, such as hot flushes, night sweats, emotional changes and vaginal dryness.

The menopause usually occurs naturally in women between ages 45 and 55. However, loss of oestrogen can also occur if the ovaries are removed, for example during a total hysterectomy.

Why is heart disease associated with the menopause?
The loss of natural oestrogen as women age may contribute to the higher risks of heart disease seen after the menopause. Other factors include:
* Changes in the walls of the blood vessels, making it more likely for plaque and blood clots to form;
* Changes in the level of fats in the blood (LDL, or ‘bad’ cholesterol increases and HDL, or ‘good’ cholesterol decreases);
* Increases in fibrinogen levels (a substance in the blood that helps it clot). Increased levels of fibrinogen are related to heart disease and stroke since it makes it more likely for blood clots to form, narrowing the arteries and reducing blood flow to the heart;

How can menopausal women reduce their risk for heart disease?
Women with the lowest risk of heart disease are those who:
* Avoid or stop smoking;
* Lose weight and/or maintain their ideal body weight;
* Exercise for 30-40 minutes three to five times a week;
* Follow a diet low in saturated fat (<7% daily amount); low in partially hydrogenated fats; and high in: fibre, whole grains, pulses (such as beans and peas), fruits, vegetables, fish and foods rich in folic acid;
* Treat and control medical conditions such as diabetes, high cholesterol and high blood pressure that are known risk factors for heart disease;

Can hormone replacement reduce my risk of heart disease?
For many years, it was thought that hormone replacement therapy (HRT) could possibly reduce the risk of heart disease in women by replacing the oestrogen lost during the menopause.

More recent studies of women with existing heart disease have not shown benefits after four years on HRT. In fact, data are showing some forms of HRT may be harmful in these women.

Experts no longer recommend HRT to protect postmenopausal women against heart disease.