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IT’S TIME TO JOIN FORCES TO BATTLE A KILLERYou
may be asking yourself why a gynecologist it addressing the subject of
heart disease. The fact of
the matter is that nearly half of all women in the United States will
eventually dies of cardiovascular disease.
Anyone concerned with women’s health must be actively involved
in the prevention and management of cardiovascular risk.
While the focus of preventive medicine in women’s health care
continues to be reproductive disease, cardiovascular deaths (even during
the reproductive years) are 21 times higher than that due to
“female” causes. Studies
indicate that gynecologists are the primary care physicians to thirty
percent of women during their childbearing years.
Physicians in this medical specialty also prescribe oral
contraceptives and hormone replacement therapy, both of which play
important roles in cardiovascular risk in women.
Any doctor that functions as a primary care physician must
continuously assess his or her patient’s cardiovascular risk;
monitoring – and counseling- on changeable factors such as smoking
habits, blood pressure levels, exercise patterns, and diet. Heart
disease kills about 375,000 women annually in this country compared with
about 40,000 deaths from breast cancer and many fewer from endometrail
cancer. In postmenopausal
women the rate of cardiovascular disease equals that of men.
Some studies indicate that women are reaching equally in cardiac
risk, at younger ages, but whether this is due to stress, poor diets, or
the long-term effect of oral contraceptives is unclear. The trend however is quite clear and is a major concern of
all health professionals. ESTROGEN
AND HEART DISEASE Studies
have found that estrogen replacement therapy, which relieves many
menopausal symptoms and preserves bone mass, also reduces the
postmenopausal rise in heart disease by half.
Estrogen is the natural female hormone produced by the ovaries
until menopause, when levels of estrogen decline sharply.
The addition of progestin to cyclical estrogen replacement
therapy raises concern about the possible blunting of estrogen’s
beneficial effect. Estrogen
replacement therapy (ERT) has been linked to an increased risk of
endometrail and breast cancer and for these reasons has been the center
of a great deal of controversy. For
most women, the benefits of hormone replacement therapy far outweigh the
small-added risk of cancer. In
high-risk women – persons with a family history of female organ cancer
– decisions regarding hormone therapy must be weighed very carefully. A
thorough discussion with your physician about your risk factor profile
for heart disease, osteoporosis, and cancer will help you make an
informed decision about estrogen replacement therapy. Researchers
are actively testing drugs which mimic estrogen in their anti-heart
disease effects but which also have anti-estrogen effects to prevent
breast cancer. Medical
researchers are aggressively searching for the specific medication mix
to help manage these critical risk factors. The
role of oral contraceptives in women’s health is of particular
importance because the potential period of use can span thirty years in
a woman’s lifetime. Lowering
the dosage of steroid hormones in oral contraceptives has already
modified some of the cardiovascular risk.
All birth control pills are not created equal, however, and the
relative potency of the hormones, especially the progestin component, is
also implicated in the risk of arterial disease. Studies
have shown that the earliest indication of arteriosclerosis is present
in women in their teens and 20’s, even though angina and heart attacks
do not develop until much later in life.
It is therefore of the utmost importance that all the health
decisions made in woman’s life include an evaluation of the possible
increase in cardiovascular risk. Be
sure to share as much information about your family’s medical history
as possible with your gynecologist- especially if many of your close
relatives have had heart disease-so that this can be taken into
consideration when medications are indicated. This
way, your physicians, (from multiple areas of specialization), can work
with you as a dedicated team to help you enjoy a heart healthy
lifestyle.
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Randy A. Birken, M.D., F.A.C.S., F.A.C.O.G. Copyright 2000-2006 Randy A. Birken, M.D., F.A.C.S.,
F.A.C.O.G. All Right
Reserved
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