by Dyvette Warren, PA-C

Why is heart disease the leading cause of death in women? Why are women and men being diagnosed with coronary artery disease at younger ages than ever before? Why has heart disease become so prevalent in the last 100 years?

All women face the threat of heart disease. Becoming aware of the symptoms and risks unique to women, as well as eating a healthy diet, free of processed foods and toxins, and exercising regularly, can help protect you.

Coronary artery disease is caused by plaque forming in the lining of the arterial walls. This plaque is deposited along the arterial walls and can eventually rupture and block blood flow to a part of the heart resulting in tissue death. This is called a myocardial infarction (heart attack). Inflammation plays a key role in arterial plaque formation.

If I have plaque in the arteries of my heart, what symptoms do I look for?

The most common heart attack symptoms in women are pain, pressure or discomfort in the chest; however, it’s not always severe and is often dismissed. Women are more likely than men to have atypical symptoms that may seem unrelated to a heart issue, such as:

• Neck, jaw, shoulder, upper back or abdominal discomfort
• Shortness of breath with or without chest pain
• Right arm pain, left arm pain
• Upper or mid back pain
• Diabetics often present with fatigue and elevated blood sugar without chest pain
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue
• Women’s symptoms may occur more often at rest or while sleeping
• Emotional stress may also trigger heart attack symptoms

A 42 year old neighbor knocked on my door 5 years ago and said, “Something is wrong”. After a normal cardiac stress test several weeks before, medications for cholesterol and hypertension were prescribed by the cardiologist. This 42 year old mother of 2 young children had a standard and thorough evaluation with her primary care provider and cardiologist. She was advised to follow up in 6 months or sooner if symptoms worsen.

I knew from my training and experience that when a patient experiences feelings of “impending doom”, a thorough investigation should follow. After careful questioning, she reported only slightly elevated cholesterol and blood pressure diagnosed by her primary care provider. The reason for the knock at my door and the visit to the cardiologist was the chest pain that occurred at rest, in the middle of the night, while sleeping, that would awaken her.

The next step would be to check her lungs and coronary arteries, so I ordered a coronary angiogram (a CT scan that looks inside and around the arteries of the heart). This test included a good view of the lungs as well. Shortly after the procedure was completed, a radiologist contacted me and advised immediate cardiac evaluation for severe plaque in two major coronary arteries. This information meant that a myocardial infarction (heart attack) or death could imminent. I contacted the patient’s cardiologist to explain the severity of the situation and advised that he meet this patient at the hospital right away. The patient received coronary artery bypass surgery the next morning! The patient has implemented life style changes that will decrease the risk of worsening cardiovascular disease and is living a full and productive life with her family.

What are the risk factors for the development of heart disease in women?

• Diabetes, insulin resistance, and elevated blood glucose levels without a diagnosis of diabetes, significantly increases the risk of heart disease in women more than men.
• Metabolic syndrome – a combination of fat around the abdomen, high blood pressure, high blood sugar, and high triglycerides.
• Emotional stress and depression affect women’s hearts more than men’s. Depression makes it difficult to maintain a healthy life style and follow recommendations. Depressive symptoms must be addressed.
• Smoking is a greater risk factor for heart disease in women than in men.
• Exposure to toxins, which trigger inflammation in the body.
• Lack of physical activity is a major risk factor for heart disease, and as a group, women tend to be less active than men.
• Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels.
• Pregnancy complications such as high blood pressure or gestational diabetes can increase a woman’s long-term risk of developing heart disease in both the mother and in her children.

Where do the toxins come from that get into my blood stream?

Manmade chemicals from personal care products, toothpaste, shampoos, bubble baths, shower gels, makeup, perfumes, deodorants and lotions can be quite toxic. House hold cleaning supplies, detergents, prescription drugs and over the counter medications, smoking tobacco, industrial pollution, pesticides, contaminated water, processed foods, flavorings and additives, hydrogenated, partially-hydrogenated or trans fats all contribute to our toxic load.

Abnormalities in intestinal flora, nutritional deficiencies, and lack of sun exposure all contribute to toxic buildup as well. The body tries to fix and protect the vessels from toxins by using white blood cells to capture or trap the toxins. Atherosclerotic plaque begins to form in the lining of the vessels which narrows blood flow to vital organs. Coronary artery diseases cause 1/3 of all deaths in the western world annually.

Is cholesterol good or bad?

Cholesterol is vital to the healthy function of your body. Cholesterol is needed for the synthesis of many hormones such as testosterone, estrogen, DHEA, progesterone, and cortisol. Together with sun exposure, cholesterol is required to produce vitamin D, and deficiency in vitamin D increases risk of cancers and other ailments. Cholesterol is an essential element of all cell membranes, where it provides structural support and may even serve as a protective antioxidant. It is essential for conducting nervous impulses. If elevated cholesterol levels are the cause of coronary artery disease, why do so many people who have heart attacks have normal cholesterol and so many people with high cholesterol live into their 90s? Please read more about cholesterol and statin drugs here.

What can I do to decrease my risk of a heart attack?

• Try to find natural, non-toxic alternatives to any products you use that are on the market.
• Avoid processed/packaged foods.
• Keep blood glucose (sugar) controlled.
• Eat organic whole foods.
• Start exercising.
• Lose weight if you are overweight.
• Never smoke or quit now if you do.
• Limit alcohol intake.
• Get screened for heart disease.
• Manage stress.
• Treat Depression.

What are the tests that I should have done that will let me know if I am at risk for heart disease?

Clinical indicators for testing include an inflammatory checklist to asses overall inflammation. . Further testing is warranted if you answer yes to any of the following:

• Digestive disorders
• Bone and joint pain
• Skin conditions
• Poor health of teeth and gums
• Metabolic syndrome/diabetes
• Endocrine/hormone issues
• High blood pressure
• Chronic pain
• Sleep issues
• Chronic Fatigue
• Chronic infection(s)
• Autoimmune disease

We are now able to test 5 elements related to heart disease. The Coronary Artery Disease Inflammation Profile focuses on five key elements of cardiovascular health: sympathetic drive, antioxidant defense, immune activity, endothelial function, (and cholesterol?-the controversy continues!). It not only assesses sympathetic function and oxidation, but also provides an extensive view of inflammation to allow for more targeted and personalized interventions.

1. Sympathetic drive: Low sympathetic drive is inversely related to control of inflammatory cytokine levels, and the underlying cause of sleep disorders and depression.  Testing includes norepinephrine, serotonin, glycine, taurine, and glutamate levels.

a. Must have norepinephrine, serotonin, and dopamine controlled.

b. Serotonin has a vasodilator effect that increases blood flow and decreases blood pressure.  Lower levels are associated with an increased risk of heart disease.

c. If norepinephrine is very low OR very high, this suggests severe endothelial inflammation.

2. Oxidation:  Oxidative stress in humans can cause cancer, Parkinson’s, Alzheimer’s, heart disease, heart failure, chronic fatigue, infection, disorders related to the skin, and other health problems.  This test is for risk and vulnerability, looking at levels of harmful oxidized cholesterol, ApoB and ApoA1 ratio, and DOPAC, the oxidized form of dopamine.  These levels help to identify whether free radicals are affecting the nervous system and catecholamine function.

3. Inflammation:  Testing Myeloperoxidase, C-reactive protein, and cytokines.  These levels help to stratify risk of heart disease as well.

4. Endothelial function: Mechanical measurement and biomarker measurement to test endothelial dysfunction.  The endothelium is the largest organ in the body, made up of cells that line every blood vessel.

5. Plaque rupture/Plaque accumulation: testing cytokines.  This is the first cardiac assessment to show improvement in as little as 2 to 4 weeks; no more waiting 3 to 6 months to assess effectiveness of therapy.

I recommend that you make an appointment with one of our providers if you are experiencing symptoms or have risks that are discussed in this article, if you have a family history of coronary artery disease, blood clots, or stroke, if you have had heart surgery, bypass or stents placed in your heart or extremities. We will determine the testing needed to fit your profile that will help to determine your future risk of a heart attack.

Other tests that may be recommended to assess risk include heart scan with calcium scoring, EKG, stress tests, nutrient testing, heavy metal testing, sleep study, psychological assessments, and ultrasounds of the heart, carotid arteries, extremities, and/or aorta.

Coronary artery disease is a serious cause of morbidity and mortality in women and will continue to gain importance as a woman’s life expectancy increases. Important differences in presentation, risk factors, investigation, and treatment of women exist and should be recognized. There is plenty you can do to prevent and treat coronary artery disease. Start by committing to a healthy lifestyle.

Resources:

www.jpands.org

www.heart.org

www.mercola.com

www.neurorelief.com

www.mayoclinic.org