Women and Cardiovascular Disease
Gary S. Donovitz, M.D., FACOG
February is Heart Awareness Month.
Are women any different than men when it comes to cardiovascular disease?
Cardiovascular disease remains the leading cause of death in both men and women. More women than men have died over the past 20 years. This is surprising since after age 40, 49% of men and 32% of women will develop coronary heart disease.
Interventional cardiology seems to preferentially treat more men than women. This translates to more men receiving balloon angioplasties and stent procedures.
Is it just an access problem or are their sex related differences? In fact, there are different expressions of cardiovascular disease in women with more small vessel disease and more diffuse vascular injury.
The literature has always supported estradiol as a protector of the cardiovascular system in women. Estradiol is a vasodilator increasing nitrous oxide production. It is interesting that there is no abrupt rise in the prevalence of cardiovascular disease in women at the time of menopause.
Women also have higher incidence of co-morbidities such as metabolic syndrome, diabetes, auto-immune diseases, higher percentage of body fat, and type 2 hypothyroidism.
Over the past two decades, physicians have treated the high incidence of hypercholesterolemia in women with statins and more statins. The benefits of statins have been negligible, as reported in Menopause 2015. In fact, there is no benefit to statins in primary prevention of cardiovascular disease in women.
The benefits of testosterone on insulin resistance in men has been reported in multiple studies. There is a paucity of information as regards testosterone as an insulin sensitizer in women although anecdotally we have seen its benefit in thousands of patients.
The fact that testosterone also has numerous benefits on the heart including increased blood flow, decreased inflammation and a reduction in plaque in the coronary arteries has been under reported and insufficiently studied in women.
With 40-50 million Americans having Type 2 Hypothyroidism and the incidence Hashimoto’s thyroiditis on the rise, we must be more diligent in our work-up and treatment of thyroid disease. Optimization can reduce cardiovascular disease and arrhythmias.
In summary, as we all continue to heighten our awareness about cardiovascular disease in the month of February and beyond, let us abandon those therapies that have not shown benefit, and begin trials on therapies like hormone optimization that look promising and could reduce cardiovascular mortality as we go forward. We should also begin studies that bring women into the mix, so that the incidence of insulin resistance, diabetes, and autoimmune abnormalities could be reduced in the near future.
Questions or comments can be sent to Gary S. Donovitz, M.D., President and Medical Director of BioTE Medical at firstname.lastname@example.org.
Gary Donovitz, M.D., FACOG, FRSM, has been an innovator in bio-identical hormone replacement for 20 years. He is the Medical Director for The Institute for Hormonal Balance. Over the past seven years he has championed the mission of changing healthcare through an individualized, comprehensive method of hormone optimization. He is considered an expert in the field of subcutaneous hormone pellet therapy and is an international lecturer on the subject. Dr. Donovitz has performed more than 50,000 pellet insertions. His new book, "Age Healthier...Live Happier, How to Stop Overmedicating Through Natural Hormone Balance" was published in March of 2015.
Return to February 2017 e-Journal