It is that time of year again: February 7th is National Wear Red Day to raise awareness in the fight against heart disease in women. Heart disease is the leading cause of death among women over the age of 20 in America. It’s actually more deadly than all forms of cancer combined-killing nearly 300,000 women each year. In fact, one in three women will eventually die from this silent killer.
The good news is that 80 percent of heart-related illnesses can be prevented if women make the right choices regarding their health and become educated on the avoidable dangers that put their heart health at risk. Some of these preventions dove-tail right into the New Year’s resolutions from last month:
*quit smoking and avoid 2nd hand smoke
*process out processed food from your diet
*Know your “numbers”
Most patients are now familiar with mainstream cardiovascular risk factors such as high cholesterol and triglyceride levels. Physicians are starting to request an even more comprehensive analysis including CRP (C-reactive protein), homocysteine and fibrinogen. All women should know their numbers for the following 5 risk factors:
2-cholesterol (broken down into total, LDL (“bad” cholesterol), HDL (“good” cholesterol) and triglycerides)
3-glucose or A1C
4-body mass index
How does this relate to hormones? The Women’s Health Initiative (WHI) study reported that women taking estrogen and progestin had higher risks of heart disease than those taking the placebo. The WHI participants only utilized oral conjugated equine estrogens and oral medroxyprogesterone. A more recent study published in the European Heart Journal demonstrated a lower risk with transdermal or vaginal application of estrogen. Endocrine Review published a very comprehensive report on progestins elucidating the difference between the substantial number of individual progestogens employed in hormone replacement. They concluded the differences in chemical structure, metabolism, pharmacokinetics, affinity, potency and efficacy via steroid receptors, intracellular action, and biological and clinical effects confirm the absence of a class effect. This means the progestogen chosen is significant in determining these risks. If your symptoms necessitate hormone replacement, discuss in depth with your physician all the options.
JAMA July 2002 288(3)
Endocrine Review April 2013 34(2)
European Heart Journal (2008) 29.2660-2668