"When it comes to CAD, treating a woman requires different skills."
(DR. STEPHEN SINATRA)
Q: Public health organizations have been hammering home their "Red Dress" campaign and the idea that heart disease is the number-one killer of women. Is it really possible that women still underestimate their risk?
A: I strongly believe that women underestimate their risk. Women really fear breast cancer. Even in 2008, that's still their number-one concern. I think that fear of breast cancer is overwhelming for a woman. The problem is that women still don't get it. They feel that heart disease is a male-oriented disease.
Q: OK, coronary artery disease is the leading killer of women, but what age group are we talking about? Don't women get it much later in life than men do?
A: The earliest heart attack I have seen in a woman was in a 17-year-old. But generally women lag 10 years behind men. The average male gets it at 55 and woman at 65, but—and a big but here—a woman's instance of coronary artery disease (CAD) skyrockets after the age of 45. Once she starts developing perimenopause, her risk goes up by 400%. And 45- to 50-year-old women are at the greatest risk of heart disease.
Q: How has the trend of women not taking hormone replacements after menopause affected risk for CAD? Where is this trend headed?
A: First of all, back in 2000 or so, when the Women's Health Initiative test was going on, and any studies before that, it was suggested that women were protected from heart disease. But women were suffering more heart attacks and strokes. The problem is that we don't know the data over the last few years. We don't have any long-term data. Basically we have to look at the data we do have and what kind of estrogen therapy was used. The jury is still out on that, but I will say this: When it comes to hormonal replacement in women, it's all about quality of life and symptoms. It's not about a fear of getting heart disease or protecting the bones. Women have to just forget about that data. Their greatest concern is a quality-of-life issue. If a woman cannot live in her body and she's suffering, she may choose bio-identical hormone replacement therapy, which has the lowest risk.
