Susan Merenstein, Pharmacist/Owner

(412) 586-4678

Women's Heart Disease, Heart Attacks, and Hormones

You can cause or help prevent cardiovascular disease, depending on the hormone you choose.

I'm about to give you a lot of seemingly discouraging statistics about women and heart disease, but stay with me — by the end of this article you'll know a lot about how to prevent heart disease.

The rate of death from heart disease in the United States has gradually declined over the past 25 years, but that decline has been much steeper for men than for women. According to the American Heart Association, "Every minute in the United States, someone's wife, mother, daughter or sister dies from heart disease, stroke or another form of cardiovascular disease (CVD). More than one in three women is living with CVD, including nearly half of all African-American women and 34 percent of white women." The Centers for Disease Control and Prevention state that heart disease is the leading cause of death for women in the United States, killing 291,188 women in 2009 - that's 1 in every 4 female deaths. Until a few years ago, doctors didn't take heart disease symptoms in women very seriously — one out of three of them didn't even know it is the leading cause of death in women, more than all other causes of death combined. Eventually, with age, approximately 50 percent of women die of heart disease.

Women are more likely to die of a first heart attack, and two-thirds of them have no previous symptoms, compared to only half of men who have no previous symptoms. Some people guess that the women do have previous symptoms, but either don't go to the doctor for them, or the doctor doesn't take them seriously. It is also possible that the cause or mechanism of women's heart problems is different in some way to that of men.

One year after a heart attack, 44 percent of women have died, as compared to only 27 percent of men. Although women tend to live about seven years longer than men, they spend twice as many years disabled before they die.

Chest pain is the most common symptom of heart disease and heart attack in both men and women, but women having a heart attack are more likely to complain of upper abdominal pain, difficulty breathing, nausea and fatigue.

We don't know whether taking aspirin prevents heart disease in women. We do know that hysterectomy, with or without the removal of the ovaries, leads to a much greater risk of heart disease, and that this risk is somewhat, but not entirely, lessened by taking estrogen.

Challenging Hormone Dogma

The prevailing dogma about women and heart disease has been that it increases rapidly after menopause, and the assumption is that this is due to estrogen deficiency. However, Harvard researcher Meir Stampfer, M.D., recently presented a controversial paper at a menopause symposium in Florence, Italy, showing that a woman's increasing risk of heart disease is correlated with age, but not with menopause. What makes this intriguing to me is that his information was based on pre-1985 data, and more recent data shows that there is a correlation with menopause. Some research shows that women's risk of heart disease eventually exceeds that of a man's. Has something created a correlation between death from heart disease in women and menopause since 1985?

Women's Symptoms Point to Spasms

It is oxidized LDL cholesterol that clogs the arteries and leads to a heart attack. However, only 50 percent of coronary artery disease (CAD) deaths are associated with clogged arteries, and the majority of those are men. Autopsies show that plaque-obstructed arteries in women are considerably less clogged than those of men, most often only 20 to 30 percent blockage, which is not sufficient to cause their deaths. Men, by contrast, tend to have more than 90 percent occlusion when they have a heart attack.

Chest pain is the most common symptom of heart disease and heart attack in both men and women, but women having a heart attack are more likely to complain of upper abdominal pain, difficulty breathing, nausea and fatigue. Syndrome X is a cluster of heart disease symptoms that almost exclusively affects menopausal women. The symptoms of women with Syndrome X include exertional angina (chest pain in response to exercise) and a positive response to diagnostic exercise testing, and yet they have clear coronary arteries.

Prior to menopause (surgical or otherwise) women may have what are considered to be heart disease risk factors such as high cholesterol and blood pressure, yet they rarely die of a heart attack. So how do women die of heart attacks after menopause? Perhaps we can take our clue from research done by Dr. Kent Hermsmeyer, and others.

Provera Makes Arteries More Prone to Spasm

Hermsmeyer and his colleagues set out to study the effect of hormones on coronary artery spasm. They removed the ovaries from 12 rhesus monkeys to simulate menopause. Then six of the monkeys were put on estradiol (an estrogen) and natural progesterone, and six were put on estradiol and the synthetic progestin medroxyprogesterone acetate or MPA (Provera). Four weeks later the monkeys were injected with a combination of serotonin plus a platelet extract (thromboxane A2) known to stimulate coronary artery spasm. The monkeys that were on MPA and estrogen suffered from an unrelenting spasm that would have caused death had they not been injected with a drug that reversed the spasm. The monkeys that had been treated with estradiol and natural progesterone showed very little coronary artery spasm.

These findings are echoed by work done at Wake Forest University’s Bowman School of Medicine in Winston-Salem, NC, led by J. Koudy Williams. Their research with monkeys, heart disease and hormones has shown that medroxyprogesterone “can obliterate the beneficial effect of estrogen therapy on the progression of coronary artery atherosclerosis,” which is clogging of the arteries.

At London's National Heart and Lung institute, in a study led by Peter Collins, women on different combinations of hormone replacement therapy were put on a treadmill. Once again, those who were using natural progesterone with estrogen could exercise significantly longer than those who took medroxyprogesterone.

My hypothesis is that the increased risk of cardiovascular disease now associated with menopause may not be due to relatively minor cholesterol plaque or to hormone deficiency per se, but to increased risk of coronary vasospasm caused by synthetic progestins such as medroxyprogesterone acetate used in HRT. This does not ignore the effects of aging and the other factors listed in the box on this page, it points the finger at a dangerous drug.

There's absolutely no excuse for any doctor to prescribe Provera for HRT when we have this kind of data. HRT should include small, physiologic doses of transdermal natural progesterone, which will protect against coronary vasospasm, combined with very small amounts of estrogen, when needed.

For now it’s enough to say that when it comes to optimal cardiovascular health, some women may benefit from a small amount of estrogen. But it is quite probable that for many women, postmenopausal production of estrone in fat cells may be sufficient when supplemented with natural progesterone.

An Anti-Spasm Mineral

A deficiency of the mineral magnesium can greatly increase the chance of a coronary vasospasm, and it is also implicated in mitral valve prolapse. Magnesium deficiency is common but generally unrecognized in the US, and yet cardiovascular survival correlates with magnesium concentrations, and higher cardiovascular disease mortality correlates with magnesium-depleting factors such as diuretic usage, diabetes, digoxin therapy, alcohol, age, congestive heart failure, diarrhea, and dietary deficiency.

A daily supplement of 300 to 400 mg of magnesium glycinate is good preventive medicine. It should be taken with no more than twice the amount of calcium for optimal absorption.

I hope this information on women and heart disease will create controversy and commentary, inspire research, and most of all, save lives.

Other Factors in Heart Disease

Homocysteine: Homocysteine is a waste product of methionine that is normally converted into a safer compound for excretion in urine. If it isn't converted, it accumulates and contributes to heart disease. The activated B vitamins B6, B12, and folic acid play key roles in the conversion of homocysteine, and deficiency can cause high homocysteine levels.

Antioxidants: In the Nurse's Questionnaire Study and the Harvard Men's Study, those whose intake of vitamin E equaled at least 100 iu experienced 35 to 50 percent fewer heart attacks, and a more recent study from Great Britain showed as much as a 70 percent reduced risk. Vitamin E is especially effective because it is fat-soluble and thus more likely to supply oxidation protection to fatty compounds such as cholesterol. In considering the potential benefit of water-soluble vitamin and mineral antioxidants it is probably wise to include vitamin C and selenium, also. I recommend daily: 400 IU of vitamin E, 200 mcg of selenium, and at least 1000mg three times a day of several forms of vitamin C.

Oils: Many studies show the benefits of eating fish, nuts and seeds which contain heart-healthy oils, and olive oil. Avoid hydrogenated and unsaturated oils.

Veggies: People who eat more fresh fruits and vegetables, and more fiber, have less heart disease.

Alcohol: People who drink a glass a day of red wine have less heart disease.

Sugar and milk: Cut sugar and refined carbohydrates, and stay away from milk after puberty.

Iron: Excess iron can promote oxidation reactions that increase the risk of heart disease. Unless you are anemic, find a multivitamin without iron.

Exercise: Moderate, enjoyable exercise greatly reduces heart disease risks, such as dancing, walking, and swimming.

Weight: While true obesity increases the risk of heart disease, the moderate weight gain most women experience around menopause is not harmful.

For more by Dr. Lee on heart disease, read Dr. John Lee's Commonsense Guide to a Health Heart.
For more on heart disease drugs, their side effects and natural alternatives, consider reading Prescription Alternatives.

Legal Disclaimer: The products, articles and other content on and related sites are not offered for the diagnosis, cure, mitigation, treatment, or prevention of any disease or disorder nor have any statements herein been evaluated by the Food and Drug Administration (FDA). Said content is not intended as medical advice. Please consult your health care professional with regard to matters pertaining to your health.