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 INTERVIEW WITH
DR. ISADORE ROSENFELD
Rossi Distinguished Professor of Clinical Medicine/Cardiology, Weill Medical College, Cornell University
CBS CARES: At what age do women have an increased risk of heart attack?
DR. ROSENFELD: The heart can fail for a number of reasons. If we're talking about heart disease due to factors such as rheumatic fever or a viral infection, women can develop it at any age.
But if we're focusing our discussion on vascular disease of the coronary arteries, which is the larger problem, the risks for most women rise sharply after the menopause. At this stage, they are at least as vulnerable as men for this type of heart disease. I should say that there are some cases of vascular heart disease before menopause, for example, if a woman has diabetes or is a heavy smoker, but they are not as common as in men.
CBS CARES: Why do women become equally susceptible as men to heart disease after menopause?
DR. ROSENFELD: We don't know the reason. Presumably it's because of the decrease in the amount of estrogen, a female hormone that they make.
CBS CARES: Why is heart disease in post-menopausal women often undiagnosed by doctors?
DR. ROSENFELD: Because over the years some doctors have fallen into the mindset that women are not at risk…that's because women rarely have heart disease prior to menopause. So, those doctors tend to overlook the fact that women are very vulnerable to heart disease after menopause. Also, some physicians don't take women seriously enough.
And even today when a woman complains of a chest symptom, the immediate assumption is "she's nervous. It's her period. It's her menopause" And so on….
It's very important for doctors and women to realize that women are very vulnerable to heart disease after the menopause and doctors should inform female patients to pay attention to all the risk factors that can provoke this disease.
CBS CARES: How specifically should women and their doctors deal with the risk of heart disease?
DR. ROSENFELD: Doctors should not wait until after menopause to tell women of the risks. They should be informing and monitoring them for heart disease long before menopause. If a woman has her risk factors ignored prior to menopause she may well get hit harder after menopause. So the new directions of the American Heart Association is to focus on women of all ages, recognizing heart disease when it occurs and preventing it before they are vulnerable.
CBS CARES: What are these new directions that the American Heart Association is giving out?
DR. ROSENFELD: The American Heart Association has put women into several categories: those with risk factors, post-menopausal, or already with some manifestation of heart disease. These women are high-risk women and have to be treated vigorously. Then there are women at lesser risk but should still take the necessary preventative measures that are necessary.
CBS CARES: What are these risk factors?
DR. ROSENFELD: They include diabetes, smoking, excess weight, high cholesterol, physical inactivity and genetics. The only one you can't do anything about is genetics.
CBS CARES: Is it true that the total cholesterol levels for a woman are not as strong an indicator of heart disease risk as they would be for a man?
DR. ROSENFELD: They say that, but I have not found it to be so. I mean, I can't go by statistics. If a woman has what is considered to be an abnormal cholesterol level, with or without an accompanying high HDL, I treat those people the same as men with the same problem. If a woman comes in with very high cholesterol and very high protein LDL levels, I treat her vigorously.
CBS CARES: So, basically, in your opinion, high cholesterol in a woman is in fact a strong indicator of potential for heart disease?
DR. ROSENFELD: Yes, but when I see high cholesterol, the first thing I check is their thyroid. People with a low thyroid have high cholesterol. But in the presence of a normal thyroid I'd consider high cholesterol to be an indicator of an increased risk of heart disease for both women and men.
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