Conditions

Empowering Women’s Heart Health: Know the Risks, Embrace Wellness

For a substantial period, cardiovascular diseases, including heart disease, were commonly associated with men. However, the stark reality remains that heart disease continues to be the leading cause of mortality for both women and men across the globe. Though historically eclipsed by the attention devoted to men’s cardiovascular concerns, the narrative surrounding women’s heart health is now rightfully taking center stage.

In this article, we’ve delved into the intricacies of women’s heart health, shedding light on the unique physiological characteristics and distinct health considerations specific to women. From the heightened risk following menopause to the significant influence of hormones, we’ve uncovered the factors contributing to this gender-specific health concern.

I also recommend Sarah Marinos’ informative article in the House of Wellness, where I provided expert commentary. You can access it here (link).

 

Risk factors for heart disease in women

While heart disease affects both men and women, there are specific risk factors that women should be mindful of, especially as they age and undergo hormonal changes. Understanding these risk factors and taking proactive steps to manage them can significantly reduce the likelihood of heart disease and promote a heart-healthy life.

Several risk factors for heart disease are more common in women than men. These include:

  1. Age: Women face an increased risk of heart disease as they age, with the risk typically rising after menopause, which typically occurs between the ages of 45 and 55. The hormonal changes during menopause can affect cholesterol levels and increase the risk of developing heart-related issues.

  2. High Blood Pressure: High blood pressure, also known as hypertension, is a significant risk factor for heart disease in women and is, in fact, more common in women than in men. Notably, high blood pressure, known as gestational or postpartum hypertension, can sometimes occur during and after pregnancy. This temporary increase in blood pressure can have long-term implications for a woman’s heart health if not properly managed. Therefore, women must monitor their blood pressure during pregnancy and postpartum and seek medical guidance if hypertension is detected. Additionally, women should continue to monitor their blood pressure throughout their lives, as hypertension can develop or persist beyond the childbearing years, posing an ongoing risk to heart health. Regular check-ups and lifestyle modifications are essential in managing high blood pressure and reducing the risk of heart-related issues.

  3. High Cholesterol: Women should be particularly cautious about their cholesterol levels. Having high levels of “bad” cholesterol (low-density lipoprotein, or LDL) and low levels of “good” cholesterol (high-density lipoprotein, or HDL) can significantly increase the risk of heart disease. Monitoring and managing cholesterol levels are crucial steps in preventing heart-related issues.

  4. Diabetes: Women with diabetes are at a higher risk for heart disease than men with diabetes. Diabetes can cause damage to blood vessels and nerves, increasing the likelihood of heart problems. Managing blood sugar levels through lifestyle changes and medication is essential in reducing this risk.

  5. Family History: A family history of heart disease is a significant risk factor for both men and women. Women with a family history of heart disease should be particularly vigilant in adopting heart-healthy lifestyles and seeking regular medical check-ups to monitor their heart health.

  6. Smoking: Smoking is a significant risk factor for heart disease in both genders. Women who smoke or are exposed to secondhand smoke face an increased risk of heart-related issues. Quitting smoking is one of the most effective ways to reduce this risk and improve overall heart health.

Empowering Women's Heart Health: Know the Risks, Embrace Wellness Heart Matters

The role of hormones

Hormones are intricate chemical messengers within the body, orchestrating various physiological processes, and indeed, they play a pivotal role in women’s heart health. One of the key hormones significantly influencing women’s heart health is estrogen.

Estrogen is a hormone predominantly found in higher levels in premenopausal women. It is recognized for its multifaceted role in the body, including its impact on the cardiovascular system. Estrogen has been shown to have a protective effect on the heart in several ways:

  1. Vasodilation: Estrogen helps to relax and widen blood vessels, a process known as vasodilation. This effect contributes to lower blood pressure and improved blood flow, reducing the strain on the heart.

  2. Lipid Profile: Estrogen can positively influence the lipid profile by increasing levels of “good” cholesterol (HDL) and decreasing levels of “bad” cholesterol (LDL). This helps prevent arterial plaque buildup, a significant factor in heart disease.

  3. Anti-Inflammatory Properties: Estrogen possesses anti-inflammatory properties, which can mitigate the inflammation of blood vessels and reduce the risk of atherosclerosis, a condition where arteries become narrowed and hardened.

 

 

There is a pivotal turning point in a woman’s life where the protective effect of estrogen undergoes a profound shift.

 

After Menopause: After menopause, which typically occurs between the ages of 45 and 55, estrogen levels dramatically decline as a natural part of aging. This hormonal shift can leave women more susceptible to heart disease. The protective mechanisms that estrogen once provided begin to diminish, leading to changes in the cardiovascular system that can increase the risk of heart-related issues.

Women should remain vigilant about these hormonal changes and their implications for heart health. Postmenopausal women are encouraged to collaborate with their healthcare providers to oversee and address their cardiovascular risk factors. This proactive approach may encompass lifestyle adjustments, such as embracing a heart-healthy diet, engaging in consistent physical activity, and implementing stress management strategies.

 

Pregnancy and heart health

Pregnancy is a transformative and remarkable journey for women, but it’s essential to recognize that it can also have lasting implications for heart health. Several pregnancy-related conditions and events can influence a woman’s cardiovascular well-being during and after pregnancy.

1. Gestational Diabetes: During pregnancy, some women may develop a temporary condition known as gestational diabetes. This condition is characterized by elevated blood sugar levels during pregnancy, which typically normalize after childbirth. However, experiencing gestational diabetes increases a woman’s risk of developing type 2 diabetes. Type 2 diabetes is a significant risk factor for heart disease. Therefore, women with gestational diabetes should remain vigilant about their blood sugar levels and adopt a heart-healthy lifestyle to reduce their cardiovascular risk.

2. Preeclampsia: Preeclampsia is a serious condition during pregnancy, characterized by high blood pressure and damage to other organs, typically the liver and kidneys. While it usually resolves after childbirth, having had preeclampsia is associated with an increased risk of developing high blood pressure and heart disease later in life. Monitoring blood pressure and seeking medical guidance for ongoing heart health management is crucial for women with a history of preeclampsia.

3. Peripartum Cardiomyopathy: Peripartum cardiomyopathy is a rare but severe condition that can affect women in the last month of pregnancy or up to five months after giving birth. This condition involves weakening the heart muscle, which can lead to heart failure. While the exact cause of peripartum cardiomyopathy is not fully understood, it underscores the importance of close medical monitoring during pregnancy and postpartum. Women who experience symptoms such as shortness of breath, swelling, or fatigue during this time should seek prompt medical attention to assess and manage their heart health.

 

Spontaneous coronary artery dissection (SCAD)

Spontaneous coronary artery dissection, commonly known as SCAD, is a medical emergency characterized by the development of a tear within one of the heart arteries, causing a heart attack. It occurs independent of the presence of any cholesterol plaque.

When SCAD occurs, it has the potential to impede or entirely obstruct blood flow to the heart. This situation can lead to various consequences, including heart attacks and disturbances in heart rhythm (arrhythmias).

While SCAD is most frequently observed in women between their 40s and 50s, it’s important to note that it can manifest at any age and is not exclusive to women; it can also affect men. Strikingly, individuals who experience SCAD often do not exhibit conventional risk factors associated with heart disease, such as high blood pressure, high cholesterol levels, or diabetes.

Empowering Women's Heart Health: Know the Risks, Embrace Wellness Heart Matters

 

For a more in-depth review of SCAD, please see our article linked here.

 

Takotsubo Cardiomyopathy: A Distinct Aspect of Women’s Heart Health

In the context of women’s heart health, Takotsubo Cardiomyopathy, often colloquially referred to as “broken heart syndrome,” presents a unique consideration. This condition is characterized by the sudden weakening of the heart muscles, typically triggered by intense emotional or physical stress. What distinguishes Takotsubo cardiomyopathy is its higher occurrence among women, particularly those in the postmenopausal stage. The term “Takotsubo” originates from Japanese and describes the atypical shape the heart assumes during such an episode, resembling a traditional octopus trap. While typically reversible with appropriate medical care, its prevalence underscores the intricate connection between emotional well-being and heart health in women. Understanding this condition and its triggers emphasizes the importance of stress management and emotional support as integral components of women’s heart health initiatives.

Empowering Women's Heart Health: Know the Risks, Embrace Wellness Heart Matters

 

For a more in-depth review of Takotsubo Cardiomyopathy please see our article linked here.

 

Conclusion

In conclusion, heart disease is a major health concern for women, and it is important for women to be aware of their risk factors and take steps to prevent it. By understanding the impact of hormones, pregnancy, and uncommon conditions such as SCAD and takotsubo cardiomyopathy, women can be better prepared to protect their heart health.

  1. Age: Women face an increased risk of heart disease as they age, with the risk typically rising after menopause, which typically occurs between the ages of 45 and 55. The hormonal changes during menopause can affect cholesterol levels and increase the risk of developing heart-related issues.

  2. High Blood Pressure: High blood pressure, also known as hypertension, is a significant risk factor for heart disease in women and is, in fact, more common in women than in men. Notably, high blood pressure, known as gestational or postpartum hypertension, can sometimes occur during and after pregnancy. This temporary increase in blood pressure can have long-term implications for a woman’s heart health if not properly managed. Therefore, women must monitor their blood pressure during pregnancy and postpartum and seek medical guidance if hypertension is detected. Additionally, women should continue to monitor their blood pressure throughout their lives, as hypertension can develop or persist beyond the childbearing years, posing an ongoing risk to heart health. Regular check-ups and lifestyle modifications are essential in managing high blood pressure and reducing the risk of heart-related issues.

  3. High Cholesterol: Women should be particularly cautious about their cholesterol levels. Having high levels of “bad” cholesterol (low-density lipoprotein, or LDL) and low levels of “good” cholesterol (high-density lipoprotein, or HDL) can significantly increase the risk of heart disease. Monitoring and managing cholesterol levels are crucial steps in preventing heart-related issues.

  4. Diabetes: Women with diabetes are at a higher risk for heart disease than men with diabetes. Diabetes can cause damage to blood vessels and nerves, increasing the likelihood of heart problems. Managing blood sugar levels through lifestyle changes and medication is essential in reducing this risk.

  5. Family History: A family history of heart disease is a significant risk factor for both men and women. Women with a family history of heart disease should be particularly vigilant in adopting heart-healthy lifestyles and seeking regular medical check-ups to monitor their heart health.

  6. Smoking: Smoking is a significant risk factor for heart disease in both genders. Women who smoke or are exposed to secondhand smoke face an increased risk of heart-related issues. Quitting smoking is one of the most effective ways to reduce this risk and improve overall heart health.

Empowering Women's Heart Health: Know the Risks, Embrace Wellness Heart Matters

The role of hormones

Hormones are intricate chemical messengers within the body, orchestrating various physiological processes, and indeed, they play a pivotal role in women’s heart health. One of the key hormones significantly influencing women’s heart health is estrogen.

Estrogen is a hormone predominantly found in higher levels in premenopausal women. It is recognized for its multifaceted role in the body, including its impact on the cardiovascular system. Estrogen has been shown to have a protective effect on the heart in several ways:

  1. Vasodilation: Estrogen helps to relax and widen blood vessels, a process known as vasodilation. This effect contributes to lower blood pressure and improved blood flow, reducing the strain on the heart.

  2. Lipid Profile: Estrogen can positively influence the lipid profile by increasing levels of “good” cholesterol (HDL) and decreasing levels of “bad” cholesterol (LDL). This helps prevent arterial plaque buildup, a significant factor in heart disease.

  3. Anti-Inflammatory Properties: Estrogen possesses anti-inflammatory properties, which can mitigate the inflammation of blood vessels and reduce the risk of atherosclerosis, a condition where arteries become narrowed and hardened.

 

 

There is a pivotal turning point in a woman’s life where the protective effect of estrogen undergoes a profound shift.

 

After Menopause: After menopause, which typically occurs between the ages of 45 and 55, estrogen levels dramatically decline as a natural part of aging. This hormonal shift can leave women more susceptible to heart disease. The protective mechanisms that estrogen once provided begin to diminish, leading to changes in the cardiovascular system that can increase the risk of heart-related issues.

Women should remain vigilant about these hormonal changes and their implications for heart health. Postmenopausal women are encouraged to collaborate with their healthcare providers to oversee and address their cardiovascular risk factors. This proactive approach may encompass lifestyle adjustments, such as embracing a heart-healthy diet, engaging in consistent physical activity, and implementing stress management strategies.

 

Pregnancy and heart health

Pregnancy is a transformative and remarkable journey for women, but it’s essential to recognize that it can also have lasting implications for heart health. Several pregnancy-related conditions and events can influence a woman’s cardiovascular well-being during and after pregnancy.

1. Gestational Diabetes: During pregnancy, some women may develop a temporary condition known as gestational diabetes. This condition is characterized by elevated blood sugar levels during pregnancy, which typically normalize after childbirth. However, experiencing gestational diabetes increases a woman’s risk of developing type 2 diabetes. Type 2 diabetes is a significant risk factor for heart disease. Therefore, women with gestational diabetes should remain vigilant about their blood sugar levels and adopt a heart-healthy lifestyle to reduce their cardiovascular risk.

2. Preeclampsia: Preeclampsia is a serious condition during pregnancy, characterized by high blood pressure and damage to other organs, typically the liver and kidneys. While it usually resolves after childbirth, having had preeclampsia is associated with an increased risk of developing high blood pressure and heart disease later in life. Monitoring blood pressure and seeking medical guidance for ongoing heart health management is crucial for women with a history of preeclampsia.

3. Peripartum Cardiomyopathy: Peripartum cardiomyopathy is a rare but severe condition that can affect women in the last month of pregnancy or up to five months after giving birth. This condition involves weakening the heart muscle, which can lead to heart failure. While the exact cause of peripartum cardiomyopathy is not fully understood, it underscores the importance of close medical monitoring during pregnancy and postpartum. Women who experience symptoms such as shortness of breath, swelling, or fatigue during this time should seek prompt medical attention to assess and manage their heart health.

 

Spontaneous coronary artery dissection (SCAD)

Spontaneous coronary artery dissection, commonly known as SCAD, is a medical emergency characterized by the development of a tear within one of the heart arteries, causing a heart attack. It occurs independent of the presence of any cholesterol plaque.

When SCAD occurs, it has the potential to impede or entirely obstruct blood flow to the heart. This situation can lead to various consequences, including heart attacks and disturbances in heart rhythm (arrhythmias).

While SCAD is most frequently observed in women between their 40s and 50s, it’s important to note that it can manifest at any age and is not exclusive to women; it can also affect men. Strikingly, individuals who experience SCAD often do not exhibit conventional risk factors associated with heart disease, such as high blood pressure, high cholesterol levels, or diabetes.

Empowering Women's Heart Health: Know the Risks, Embrace Wellness Heart Matters

 

For a more in-depth review of SCAD, please see our article linked here.

 

Takotsubo Cardiomyopathy: A Distinct Aspect of Women’s Heart Health

In the context of women’s heart health, Takotsubo Cardiomyopathy, often colloquially referred to as “broken heart syndrome,” presents a unique consideration. This condition is characterized by the sudden weakening of the heart muscles, typically triggered by intense emotional or physical stress. What distinguishes Takotsubo cardiomyopathy is its higher occurrence among women, particularly those in the postmenopausal stage. The term “Takotsubo” originates from Japanese and describes the atypical shape the heart assumes during such an episode, resembling a traditional octopus trap. While typically reversible with appropriate medical care, its prevalence underscores the intricate connection between emotional well-being and heart health in women. Understanding this condition and its triggers emphasizes the importance of stress management and emotional support as integral components of women’s heart health initiatives.

Empowering Women's Heart Health: Know the Risks, Embrace Wellness Heart Matters

 

For a more in-depth review of Takotsubo Cardiomyopathy please see our article linked here.

 

Conclusion

In conclusion, heart disease is a major health concern for women, and it is important for women to be aware of their risk factors and take steps to prevent it. By understanding the impact of hormones, pregnancy, and uncommon conditions such as SCAD and takotsubo cardiomyopathy, women can be better prepared to protect their heart health.

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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.

Nitrates

Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.