Mitzi Perdue

Women & Atherosclerotic Cardiovascular Disease

WOMEN NEED TO BECOME MORE AWARE OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD)

A typical woman is more likely to be afraid of breast cancer than heart disease. Yet in this country, roughly 50,000 women will die each year of breast cancer versus 500,000 who will die from heart disease. Part of the problem is they are less likely to have the typical symptoms a man has. We think of a man falling to the ground clutching his chest after shoveling snow.

With women, the symptoms may be more obscure, such as feeling tired, having shortness of breath, or feeling nauseous. Another part of the problem is that many women only see their gynecologist. Seeing an internist regularly is a good idea. An internist will be aggressive about the prevention and detection of heart problems. They can deal with the classic risk factors and will encourage smoking cessation, regular exercise, and working towards an ideal body weight.

KNOW YOUR PATIENT’S NON-HDL CHOLESTEROL NUMBER

Non-HDL cholesterol is the total cholesterol number minus the HDL (good) cholesterol. It’s a measure of the atherogenic cholesterol. According to the National Lipid Association recommendations, the optimal non-HDL cholesterol would be less than 130. If a patient’s numbers are persistently elevated despite treatment, or if there is a strong family or personal history of premature cardiovascular disease, she needs to see a board-certified lipidologist. (Find the nearest one at the National Lipid Assn’s website www.lipid.org) The non-HDL number correlates with the presence of disease better than LDL cholesterol alone. The good news is it’s something that we can lower through diet and exercise. Interestingly, the same lifestyle changes that can help prevent diabetes also help prevent cardio metabolic disease.

TRIGYCERIDES ARE A BETTER INDICATOR OF CVD THAN CHOLESTEROL

Cholesterol by itself is neither good nor bad. You need it for many functions including the structure of the cell walls and for making sex hormones. However, cholesterol is a problem when cholesterol is trafficked into the arterial walls and results in inflammation. The vehicle that transports the fats into the arterial wall is the LDL lipoprotein, an elevation of which is often indicated by high triglycerides in the modestly elevated range (100-300).

Therefore I pay more attention to triglyceride numbers than I do to the HDL and LDL cholesterol concentrations. Triglycerides are “the forgotten lipids” because they are the ignored components of the standard lipid panel. 90% of Americans don’t even know what their triglyceride numbers are. If your patient’s triglycerides are above 100, it’s a marker that there’s abnormal lipoprotein trafficking going on, and she’s at risk not only for heart disease, but also for diabetes.

STATIN DRUGS ARE AN EFFECTIVE AND SAFE TREATMENT FOR HIGH CHOLESTEROL

Your patients are likely to have heard in the popular press about some of the unproven treatments for lowering cholesterol. In general, however, these treatments do not have randomized clinical trials behind them. Nor can we be confident of their safety. In contrast, statins are proven to lower cholesterol levels and reduce cardiovascular events. Statins have some safety issues such as muscle aches and pains, but the side effects are very minor compared to their benefits.

MENOPAUSE INCREASES A WOMAN’S VULNERABILITY

With menopause and the accompanying loss of estrogen, a woman may find that her fat deposits cause her to change from pear shape to apple shape. Unfortunately, the visceral adiposity increases her risk for both diabetes and heart disease. A woman whose cholesterol has been normal all her life may suddenly find that she is at increased risk for pre-diabetes, diabetes, and heart disease. Again, lifestyle changes can make a big difference for her.

TWO NEW CHOLESTEROL-LOWERING DRUGS HAVE JUST BEEN APPROVED

Two new drugs have just come on the market that are dramatically effective at reducing atherogenic cholesterol. These are the PCSK9 inhibitors, and they are most useful to people with known dyslipidemia and clinical evidence of atherosclerosis, and who have been unable to reach their target. Individuals with Familial Hypercholesterolemia, a relatively common disease affecting one out of 250 Americans will also immediately benefit from the drugs.

RECOMMENDED WEBSITE

http://exerciseismedicine.org is a good website for more information on the benefits of exercise.
www.lipid.org is the National Lipid Association’s website.