Dr. Sarrel recalls the most common heart attack risk factors for women.
There are factors in women. Let’s talk about the factors in women that men don’t have that contribute to the occurrence of a heart attack. Smoking is number one. It’s more of a problem in women. Women deal much worse with smoking and its affect on their arteries than men.
We think that one of the reasons is that smoking’s effect on what happens to their blood estrogen level because in women, estrogen is a major protective effect to prevent heart attacks.
Another major factor is obesity; can’t forget about that. In this country it’s a major problem. In some populations, by the age, in their mid 50s half of all the population meet the criteria for being obese. If you look at the major study, what’s called the Women’s Health Initiative study, of hormones and their effects on women, those women were in their 60s when they were studied and obesity was a major problem affecting the outcome of the study.
So we have two things that women can do something about that contribute – smoking and obesity. That could be in men but then there are other issues. Hysterectomy – let’s talk about that because men don’t have hysterectomies.
A hysterectomy is the removal of the uterus, typically because of hemorrhaging or pain or infection or cancer – there are lots of reasons why a woman’s uterus would be removed. 600,000 hysterectomies are done every year in the United States.
Hysterectomy alone is a risk factor for having a heart attack. Now, we know it’s not the loss of the uterus; it’s the change in hormone production by the ovaries. In the United States every year, 600,000 women also have their ovaries removed. 300,000 have their ovaries removed when they are having their hysterectomy; the other 300,000 have their ovaries removed because there has been a family history of breast cancer and the ovaries are getting removed to reduce the risk of breast cancer.
That’s okay, but the problem is, if there is a hormone deficiency as a result, the women are going to be subjected to a major impact on their life function, all the symptoms from the hormone deficiency and that does include an increased risk of having a heart attack.
There’s another condition in women and that is what’s called premature ovarian failure, and this can be a woman in her 30s. The youngest woman I ever saw who had failure of her ovaries was 18 years old; they had started when she was 13 and they stopped working when she was 18.
Well, premature ovarian failure obviously can’t occur in men, is a factor that correlates with an increase of heart attacks later in life if the hormones that are missing are not replaced. There are other conditions in women that compromise the amount of ovarian hormone production; diseases like endometriosis which impair the production.
There’s another condition that’s quite common which is called polycystic ovarian disease. Those women have a higher risk of a heart attack. So you see here is a whole host of conditions and lifestyle factors that contribute to the risk of having a heart attack in women. No surprise that we have seen this tremendous increase in women dying of a heart attack and of women having a heart attack, and you know, there’s another issue we must get to and that’s not only the issue of life and death, it’s the issue of disability as a result of having a heart condition.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.