Women and Heart Disease

1 in 4 women die in the United States from heart disease. (1) For an over 30 year estimate, the lifetime risk of Cardiovascular Disease (CVD) among women with diabetes was 54.8% for those of normal weight and 78.8% for obese women. (2) The most common type of cardiovascular heart disease is coronary heart disease (CHD) which happens to be the number one killer of both men and women. Coronary microvascular disease is the next type of heart disease which mainly poses a risk for women. (1) But the impact of CVD in women is not solely related to the mortality rate since advances in science and medicine allow many women to survive heart disease. In the United States, 38.2 million women (34%) are living with CVD and the at risk population is even greater. (3) Following a systematic literature review completed by the American Heart Association in 2003 with the goal of developing evidence based guidelines for the prevention of CVD in women, with few exceptions, recommendations to prevent CVD in women do not vary from those of men. Of particular importance are barriers to heart health documented by the American Heart Association: 36% of women did not perceive themselves to be at risk, 25% said their healthcare provider did not say heart health was important, and 1 in 5 said health care providers did not clearly explain how they could change their risk status. (3)

Men and women alike can experience the well-known heart attack symptoms like gripping chest pains and breaking out in a cold sweat. But women can also have subtler, less recognizable symptoms such as pain or discomfort in the stomach, jaw, neck or back, nausea and shortness of breath.

Coronary heart disease is a condition where plaque builds up in the arteries ultimately to a point where blood flow is restricted and a hardening of the arteries occurs. This condition is called atherosclerosis. The plaque is a buildup of fat, cholesterol, calcium and other substances found in the blood. Key issues in literature and research on this issue focus on 1) what initiates the plaque buildup leading to restricted blood flow and 2) what causes plaque deterioration and rupture resulting in a cardiovascular event.

There can be many factors which contribute to the cause; some of the problems are more predominant in our population and the effect of some conditions are greater than others. Lifestyle factors play a significant role in the potential for CVD. Atherosclerosis can be initiated by a number of different conditions such as hypertension, diabetes, lack of exercise, heavy alcohol consumption, smoking and being overweight. (4)

It is broadly accepted that what initiates the condition for arterial plaque buildup is “endothelial dysfunction”. In simple terms, the cells that make up the artery walls are not functioning properly and so the tissue/organ is not functioning properly. One reason for this to occur is constriction (hypertension) of the network of veins and arteries in the inner layers of the artery. This results in the inability to deliver oxygen (hypoxia) and nutrients as well as remove waste products of the cells. Another reason is risk factors entering the first layer of the artery wall leading to endothelial dysfunction or injury. The most common risk factor is hypercholesterolemia which is the presence of high levels of cholesterol in the blood. (4) Research points out though that it’s not just high cholesterol but malfunction of the cholesterol system. Cholesterol plays an important role. The body uses cholesterol to make hormones, vitamin D, substances used for digestion and composition of cell walls. Cholesterol rides on the back of lipoproteins to move throughout the body. Low Density Lipoproteins (LDL) distribute cholesterol throughout the body for use. High Density Lipoproteins (HDL) collect unused cholesterol to be taken back to the liver to be reused or used for digestive system bile. You might see why a balanced role of these two is important. LDL has some other characteristics. It is also subdivided to A (large) and B (small) particles. It is the small B particles that more easily penetrate the vessel and form stronger attachments to the wall. This leads to the beginning of atherosclerosis as a result of smooth tissue growth, oxidative stress and inflammation. (5)

There is significant interplay between causes/conditions/diseases that initiate the “endothelial dysfunction” and continuation of atherosclerosis. It seems clear though that those lifestyle factors that affect appropriate blood sugar levels, the cholesterol system, and inflammation and oxidative stress are key to minimizing CHD. For example, poor carbohydrate tolerance (or insulin resistance, prediabetes, or type 2 diabetes) will lead to high insulin levels and the liver producing high triglycerides, which will lead to weight gain and obesity, which will lead to visceral fat producing inflammatory signals and activating a low grade immune response. High production of triglycerides by the liver results in LDL particles that transform into small type B. High blood sugar produces glycated LDL and HDL particles. (6) This is but one scenario.

For our patients at Keady Family Practice, when they gain control of their glucose/insulin, they see weight loss and the cholesterol system comes back into balance. Inflammation levels if previously present drop or disappear depending on totality of conditions. Many see reduction in blood pressure (hypertension) as the reduction of insulin levels ultimately reduce angiotensin II levels along with lower sodium retention levels. This is accomplished through an integrated process of medical and lifestyle changes which result in greatly improved CHD risk and reduced or often eliminated medication.

Our cultures lifestyle conditions are such that all women should seek an evaluation of risk factors associated with coronary heart disease with their medical provider. This will result in knowing one’s level of risk and an appropriate stage of treatment including lifestyle and medical prescriptions. Advanced levels of risk may require immediate pharmacological and medical support. Once one’s circumstances have been assessed and any immediate risk controlled, evaluation of one’s lifestyle and necessary changes should be made. Research shows that 85% of all chronic disease is lifestyle related.