Our expert is Phoebe A. Ashley, M.D., Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University School of Medicine.

If there is a medical topic you would like to see explored here, please let me know!

Very best,

Mitzi Perdue

[email protected]

CARDIOVASCULAR DISEASE AFFECTS YOUNGER WOMEN

In the past, we used to think of cardiovascular disease (CVD) as a condition that might develop several years after menopause. However, lifestyle factors affecting the general population have changed this calculation. Today women are becoming vulnerable to CVD far earlier in their lives.

Risk factors such as high cholesterol, high blood pressure, and obesity contribute to CVD.. In addition, many women are delaying childbearing until they're in their mid-30s or older, and this may put some of them at increased risk for cardiovascular problems.

PREGNANCY IS A WOMAN’S FIRST STRESS TEST

A woman aged 35 to 39 is at a fivefold risk for myocardial infarction in the pregnancy period compared to a woman in her 20s. A woman who experiences any of the following during her pregnancy is at risk for future CVD issues.

•    High blood pressure
•    Pre-eclampsia
•    Gestational diabetes
•    Preterm labor
•    Small for date baby
•    Large for date baby

A woman with any of these symptoms should be carefully monitored for the rest of her life for diabetes, hypertension, and possible future CVD issues.

VASCULAR ENDOTHELIUM DYSFUNCTION MAY CAUSE ANGINA

A woman who experienced heart-related problems during pregnancy may be predisposed to angina even in the absence of plaque. Endothelial dysfunction can mean that when she needs more blood flow, the blood vessels do not respond appropriately. This can result in angina, even when the results of an angiogram appear normal.

DEPRESSION IS A RISK FACTOR

A depressed woman may not want to socialize, she may be experiencing stress, and she may skip exercising. Isolation, stress and lack of exercise are in themselves risk factors for CVD. In addition, a woman with depression may find herself consuming highly refined carbohydrates such as candy bars. She does this because short term, highly refined carbohydrates may make her feel better. However, eating these foods are likely to result in a rapid increase in glucose and insulin. Over time, this can lead to insulin resistance, which predates diabetes often by 8 – 10 years, and can lead to actual diabetes. Inflammation and vascular injury with diabetes is a serious risk factor for heart disease.

DIABETES IS A RISK FACTOR

A woman with diabetes is highly likely to have vascular disease. An individual whose diabetes is well-controlled may escape vascular disease, but 2/3 of deaths involving diabetics are attributable to CVD. The risk increases with age.

PATIENTS WITH AN AUTOIMMUNE DISEASE ARE AT RISK

Another group at risk for CVD are those with autoimmune diseases such as rheumatoid arthritis. The systemic inflammation involved with autoimmune diseases puts your patient at the same kind of CVD risk as a patient with diabetes. Monitor and treat your patient with an autoimmune disease as aggressively you would a patient who has diabetes.

SMOKING AND HEART DISEASE

Too many young women are closet smokers and they are unaware of the long-term health implications. Typically, they're doing it to keep their weight down. They risk early menopause and they'll have an almost 300% greater risk of CVD.

CAFFEINE AND ALCOHOL, IF CONSUMED, SHOULD BE IN MODERATION

Three to five caffeinated beverages a day for most women is reasonable, but more than that can put her at risk for extra heart beats and arrhythmias. Likewise, with alcohol, one drink a day is reasonable, but not more. Women metabolize alcohol differently from the way men do, and heavy drinking is likely to raise a woman's blood pressure and cardiovascular risk. Moderation is the by-word. A little is OK, a lot, not.