Historically and to this day, woman has been coming to the cardiologist office because she is taking her husband to be seen by the cardiologist. Often times, woman neglects her own welfare and wellbeing but to care for her husband and her family. Consequently, we find women in advanced stage of coronary heart disease and the presentation is quite commonly acute and severe. The purpose of this article is to encourage women and public in general to recognize and give more attention to women’s health and heart disease in particular.
It is known that prior to menopause, women seem to be protected from coronary heart disease. Through scientific research, statistical data, and power of observation, it is thought that the female hormone, Estrogen, may play a protective role naturally. However, attempting to duplicate the protective effect of Estrogen by giving Estrogen hormone replacement to the post-menopausal women failed and even showed potentially detrimental effects including acute cardiovascular event and malignancy. We don’t quite understand what it is that truly protects women from coronary heart disease before they reach menopause, and probably it is God’s design which is too complex for us to know. The important point is that after menopause, the process and progress of atherosclerosis, cardiovascular plaque and deterioration, is accelerated and achieves the same rate of morbidity and mortality as in men by the age of 65.
Our approach to address heart disease in women is to recommend initial cardiovascular screening at age 50 or 2 years after menopause whichever comes earlier. Some with surgically removed ovaries should be screened much earlier even if hormone replacement therapy is given. Initial healthy screening should include fasting cholesterol and glucose, blood pressure and pulse, complete cardiovascular history and physical including risk factor assessment, electrocardiography and exercise treadmill test. The approach to the management of cardiovascular disease is the same for men or women and it should be tailored individually.
We would invite women to come forward and seek the cardiovascular medical attention even as they accompany their husbands to seek the same.
Courtesy of Dr. Budi Bahureksa
Board Certified in Cardiovascular and Internal Medicine