Unavoidable Risk Factors For Heart Desease : Gender

In younger people, gender is a major predictor of risk. Before age sixty, one in five American men—but only one in seventeen women—will have had a coronary event. The naturally produced female hormone, estrogen, may be one of the reasons for this gender difference. But after a woman goes through menopause, this advantage is lost. Beyond age sixty, equality is the rule, and coronary artery disease kills 25 percent of women and men alike. In the United States, heart disease is the leading killer of both women and men.

However, there are a few concerns that pertain only to women. First, although the death rate from heart disease has declined for both genders, it is declining in women less rapidly than in men. Currently, 38 percent of women who’ve had heart attacks die within a year, compared with 25 percent of men.
Second, most women who die suddenly from coronary artery disease don’t have typical warning symptoms. Some may have had symptoms that they didn’t recognize as signs of heart attack because women’s symptoms often differ from men’s . Sometimes doctors pay less attention to women’s symptoms than they do to men’s because they know that younger women are less likely to develop heart disease. Academic medical centers like the one where I practice are spending more time educating young doctors to pay attention to women’s heart symptoms so that those symptoms are not dismissed as a less serious complaint, such as heartburn.

Given these issues, what should women do? Perhaps most important, they need to focus on prevention. For many years, doctors recommended hormone replacement therapy to women who were entering menopause because of evidence that it reduced the risk for heart disease as well as osteoporosis. But the heartprotective benefits of HRT have come under fire. Clinical trials have found that women with heart disease who take HRT do not actually slightly raises the risk of heart disease in both healthy women and women who have had previous episodes of atherosclerotic heart trouble.

It’s a different story for men and heart disease. While female hormones appear to provide some heart-protective benefits—at least for younger women—male hormones may contribute to heart disease in five ways:
• Boosting LDL and lowering HDL
• Promoting the accumulation of abdominal fat, which can lead to high triglyceride levels and diabetes
• Increasing the number of red blood cells and activating the clotting system
• Triggering spasms that narrow arteries
• Enlarging and possibly damaging heart muscle cells.

Scientists have discovered some of these effects after giving testosterone to laboratory animals. It will take time for researchers to determine whether a normal amount of testosterone increases a man’s risk for heart disease. Testosterone isn’t all bad for the heart—it appears to reduce the level of one newly identified cardiac risk factor, lipoprotein.