Older women more prone to CVD deaths

Do you know that cardiovascular disease (CVD) claims the lives of more women than the 16 next common causes of death in women combined?

Although many women think that their greatest health problem is breast cancer, CVD remains to be the first cause of mortality among women. It is estimated that 500,000 women die each year because of CVD, exceeding the number of deaths because of other causes, including all forms of cancer.

There are many misperceptions about risks among women. Fewer than one in 10 women think of CVD as their greatest health problem, even though it represents 45 percent of all deaths for women aged 25 and older.

Elevated cholesterol is one of the most important contributors to a woman’s risk of developing heart disease. According to Dr. Esperanza Cabral, current president of the Philippine Society of Hypertension and past president of the Philippine Heart Association and Philippine College of Physicians, the risk of CVD increases in women and it increases when they reach the menopausal age.

"By about 15 years after the menopause, the risk of CVD in women is approximately the same as the risk of CVD in men of the same age. This is attributed to the loss of the protective effect against CVD that is attributed to female hormones estrogen and/or progesterone which is possessed by women not yet in the menopausal stage," said Cabral.

Plasma cholesterol and triglycerides show a pattern of increasing in men for the first 50 to 60 years of life, then plateau and finally begin to decline. For women, the same pattern exists, but appears to occur 10 years later than men.

High density lipid cholesterol (HDL), which is the good type of cholesterol, does not show the same pattern, but women tend to have higher HDL cholesterol concentrations at least in the pre-menopausal years, which may account for lower incidence of CHD in pre-menopausal women.

Estrogen loss

As a woman loses estrogen, her body goes through potentially harmful lipid changes, such as an increase in cholesterol levels. Research also indicates that estrogen loss has a direct effect on vascular tone.

As in other developed countries, CVD is the most frequent cause of death in men and women over the age of 60 in our country. Cabral said the most frequent type of CVD in both men and women of this age is atherosclerotic cardiovascular disease.

Arteriosclerosis involves the buildup of deposits on the inner lining of the artery walls, which causes thickening and hardening of the arteries. People with elevated cholesterol are most prone to acquire such a disease.

Behavioral modification is extremely beneficial in controlling elevated cholesterol levels. In order to prevent arteriosclerosis, most physicians recommend a healthy lifestyle.

"In general, all patients suffering from CVD can benefit from a healthy lifestyle, a balanced diet, moderate to low in fat and salt and rich in fruits and vegetables," Cabral advised.

She added that maintenance of a desirable body weight, regular aerobic forms of exercise, avoidance of smoking, moderation in alcohol intake, adequate rest and sleep and stress management will help a lot in the management of CVD.

If dietary restrictions and physical activity are not enough to lower elevated cholesterol levels, medical therapy is very effective. A group of drugs called statins have been proven to lower CVD events and deaths when used to manage elevated cholesterol levels.

Statins dramatically lower the risk of dying from coronary heart disease and other causes by slowing down the production of cholesterol and by increasing the liver’s ability to remove the LDL-cholesterol already in the blood.

Because of its research-backed track record, statins have become the drugs most often prescribed when a person needs a cholesterol-lowering medication.

One big problem though with statin therapy is its cost. Statins are very costly and its price poses a challenge to hypertensive patients with average income. A welcome development is that Therapharma, a division of Unilab, has introduced an affordable brand of simvastatin (Vidastat).

Local healthcare professionals are optimistic that this move would encourage the reduction of prices for high-quality drugs that treat chronic diseases such as elevated cholesterol.

Thanks to the advanced scientific knowledge, the medical community knows more than ever about women’s health risks and can provide better treatment with medication and technology.

However, breakthroughs are worthless if not supported by behavioral modification. For medical practices to be effective, women themselves must play a major role in their own health care and take whatever steps they can to prevent these diseases from striking them.