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Menopause: Change of Life Increase Risk for Cardiovascular Disease
By Lois Thomson

John M. Costello, M.D., FACC, FACP, has discovered some interesting facts in research studies done by the American College of Cardiology, particularly the INTERHEART Study. As a result, he believes that "something is happening in and around menopause" with regard to women and heart disease.

As a Cardiologist for Washington Health System – Cardiovascular Care, Dr. Costello is familiar with the risk factors associated with acute myocardial infarction, or heart attacks. Regarding INTERHEART, he said, "They came up with statistical factors that look at heart disease, and they designated nine risk factors that are really pertinent." Those nine are smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, and psychosocial factors.

The study covered both men and women, of various ethnic backgrounds and geographic regions. Among the statistics, Dr. Costello said they learned that coronary disease develops 10 years later in women than in men. Basically, men have more heart disease before the age of 50; by about the age of 60 it's roughly equal; then women predominate after age 60.

"The theory about this," he said, "was that men just abused themselves more when they were younger – they were heavier smokers, they drank more, they ate more. But one of the other theories was that the estrogen in the pre-menopausal women was very protective. The interesting part is that 15 or 20 years ago, there was a big push to replace estrogen in females. But it didn't seem to work, and the data suggests there were more cardiac events in the treated patients. So replacing estrogen never really panned out, but that's still the theory."



Symptoms for hearts attacks in women may be different from those in men. These six symptoms are common in women:

  • Chest pain or discomfort
  • Pain in either arm, or the back, neck, or jaw
  • Stomach pain or severe abdominal pressure
  • Shortness of breath, nausea, or lightheadedness
  • Nervous, cold sweat
  • Fatigue

Similarly, hypertension for men is greater than for women under the age of 45; between 45 to 64 it's about equal; and then women surpass men after the age of 64. "Those numbers sort of follow along with the coronary artery disease, but whether that's tied in with the estrogen or just with aging, nobody seems to know."

A third area is cholesterol. Cardiologists want the good cholesterol (HDL) number to be above 40. Approximately 23 percent of the population's number is below 40, but in women, it's only 12.6 percent. However, two years before they go through menopause, the HDL seems to drop, and also around menopause, their bad cholesterol increases by 10 percent.

"These are the three areas I thought were fascinating," Dr. Costello said. "But the key is, in addition to paying attention to the symptoms that are different (from men's), females have to be aware that when they come into change of life, that may be a time to re check their lipid profile, be more aggressive with their blood pressure treatment, be more aware of coronary disease." Whatever the cause, the numbers are there and shouldn't be ignored. As Dr. Costello stated, "It's obvious to me that there's a big change in females as they go through change in life: there's also a change in risk."

For more information or to schedule an appointment, call (724) 225-6500 or visit www.whs.org.

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