Coronary artery disease (CAD) is this country’s number one killer of women, more so than all other diseases and accidents combined. Because of “atypical” symptoms in women and the fact that CAD is usually thought of as a man’s disease, many women don’t realize that they are often at a high risk of developing CAD, angina and related chest pain syndromes that put them at risk for heart attack or death.
CAD develops when fatty-like plaque builds up and causes disease of the coronary arteries. With thickening plaque, artery openings narrow, thus reducing the flow of oxygen-rich blood to vital heart muscle. There may be no symptoms, but as plaque builds up, angina may develop as the heart is starved of oxygen. Angina often surfaces after the patient engages in physical activity, eats a big meal or becomes emotionally distraught. Sometimes even plaques that cause mild narrowing can suddenly enlarge and cause complete blockage of the artery, leading to a heart attack or even sudden death.
CAD risk increases with age and is greater in African-American, Hispanic and Native American women, and those from poorer socio-economic backgrounds. Women with diabetes are at greatest risk for developing CAD. Other risk factors include smoking, family history, little or no exercise, high blood pressure, obesity, and high fat and cholesterol blood levels. Key preventive measures, however, can greatly reduce risk. Quitting smoking is a must. Other important measures include controlling diabetes and blood pressure, keeping cholesterol levels in check, exercising, limiting alcohol, eating a healthful diet and keeping off excess weight. Blood pressure levels should be less than 130/80 mm Hg, total cholesterol should be less than 200mg/dL with HDL levels greater than 50 and LDL levels optimally less than 100. Walking a minimum of 30 minutes a day is recommended, and a balanced diet should include a variety of vegetables, fruits, nuts, grains, fish, poultry, lean meats and low fat dairy products. Above all, don’t forget to see your doctor at least semi-annually to measure your weight, blood pressure, cholesterol and fasting glucose (sugar) to ensure that you are on the right track to heart disease prevention.
Chest pain syndromes can include three types of angina.
- Stable Angina. Brought on by activity, stable angina produces the same symptoms each time and is relieved with rest.
- Unstable Angina may occur at rest and feel more severe. While it can be treated with medication, it can lead to heart attack and should be result in a trip to the emergency room.
- Variant Angina. Although an uncommon form that usual occurs during sleep, variant angina is caused by spasm of a coronary artery. Severe spasm for long periods of time can lead to a heart attack.
Managing women with CAD includes lifestyle changes such as increasing exercise, a healthful diet, quitting smoking, and aggressively managing diabetes. Medications include blood thinners such as aspirin and clopidogrel, blood pressure lowering drugs such as beta-blockers, ACE Inhibitors, and cholesterol- and lipid-lowering medications such as statins, niacin, and fibric acid derivatives. Surgical solutions include balloon angioplasty, stent insertion, and bypass surgery to circumvent blocked coronary arteries.
MDCA cardiologists are experts at diagnosing heart disease in women. They have access to sophisticated imaging techniques such as stress echocardiography, stress nuclear imaging, heart scanning, CT angiography and MRI. They are experts at using the latest therapies to control chest pain syndromes in women and when needed, performing complex interventional procedures.
If you would like to participate in one of the current trials of treatments to improve the outcomes of patients with these problems, click here.