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Kris Godlewski

KRIS GODLEWSKI

According to statistics from the American Heart Association, more than 90 million adults are currently living with some form of cardiovascular disease.

American Heart Month provides an opportunity and a reminder to educate ourselves about cardiovascular health. In the past, we thought of heart disease predominantly as a problem of men. While much has been written over the years about the fact that women are also susceptible, this message hasn’t fully taken root. Women are rightly concerned about the risk of breast cancer, but heart disease kills far more of them than any cancer. Heart disease has been and remains the number one killer of American women, far outpacing other causes, cancer included.

It is commonly said that heart disease in women is somehow different than in men. While some differences do exist, similarities are far more important. The signs and symptoms are generally the same, the risk factors are the same and the treatment is the same. Focusing on differences rather than similarities is dangerous and, in fact, may lead to delayed recognition and treatment.

Nevertheless, women should know that while the phrase “heart disease” may conjure an image of a heart attack, that is not the most common problem by far. There is a growing epidemic of heart failure in America—and one specific type affects women three times more than it does men. Women who are overweight, have diabetes and/or high blood pressure are especially at risk, and the price they pay may be a reduced quality of life or even premature death. It is that serious. Medications are not particularly effective in this instance, but exercise and weight loss are. While we know that both can be difficult to maintain, the payoff is well worth it. Just make sure to work with your doctor to properly address all other issues, as it’s always a team effort.

Younger women are not risk-free. Those who experience problems during pregnancy, like gestational diabetes, gestational hypertension, premature delivery, or low weight birth or miscarriage, are at higher risk of developing heart disease later in life. Pregnancy is, in its own way, a cardiac stress test, and something that should be discussed with a healthcare provider.

As adults, we all should know the risks for heart disease. Even if we do, it's worth reminding ourselves of them. Some of them are out of our control, like our age, family history, and our overall genetic makeup. Others we can control, like the things we do to ourselves in our day-to-day life.

Smoking is one risk that immediately comes to mind. The rates of smoking have been declining over the years, but less so among women than men. In other words, women have made less progress in terms of kicking the habit. It is an issue that deserves our attention.

It is age, however, that is by far the most important determinant of health. Pre-menopausal women are at a lower risk for heart disease than their male counterparts, but that changes after menopause. In the past, we thought that supplementing estrogen in post-menopausal women would reduce their risk for heart disease. Research has shown that is not the case, which is why estrogen is no longer prescribed for this purpose. After all, menopause is not a disease, so there is no need to treat it. Instead, we focus on the management of high blood pressure, diabetes, and high cholesterol while addressing smoking, sedentary lifestyles, and weight management.

We have recently seen other changes in our understanding of the prevention of heart disease. For example, over the last several decades we have recommended that anyone over the age of 60 take aspirin daily, thinking it protected against heart attacks and strokes. Again, evidence has proven otherwise, so the use of aspirin to reduce the risk of heart issues is out. Aspirin does remain an essential part of treating those men and women who have already had a heart attack, undergone a bypass or had a stent placed, those who have never had any of those issues, shouldn’t take daily aspirin. There is no benefit, and aspirin has other risks associated with it, primarily that of bleeding.

All in all, our understanding of heart disease is improving but one thing remains the same: An ounce of prevention is still better than a pound of cure.

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Dr. Kris Godlewski is a cardiologist at St. James Healthcare.

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