Early menopause in women doubles the risk of CAD

By  , Jagran Cityplus
Jun 24, 2013

Coronary artery disease is widely considered as "man's disease" and not a major concern for women. But women are equally at risk. Today cardiovascular disease is the leading cause of death in women. The hurdles are assessment of coronary artery disease in women and also there is wide need to increase awareness of its existence -both among doctors and among women themselves.


As women age, particularly after menopause, they are at risk of developing cardiovascular disease. Lower levels of estrogen during and after menopause are thought to increase a woman's risk for cardiovascular disease. Early menopause, natural or surgical, can double a woman's risk for developing coronary heart disease," says Dr Anil Dhall, director and head of Cardiology, Artemis Health Institute, Gurgaon.


"Younger women are also at risk for cardiovascular disease if they smoke or have high blood pressure, diabetes and high cholesterol levels," adds Dr Anil Dhall.


Coronary artery disease (CAD) is also called coronary heart disease. It is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart muscle. This can cause angina or a heart attack.


Proper diagnosis is essential


All women above 20 should undergo tests like - FBS (fasting blood sugar), fasting lipid profile, BP check, weight/BMI/waist circumference measurement, counsel regarding smoking.  Also there must be Formal Cardiovascular risk assessment which should begin at 40. If any patient has Cardio Vascular Disease/ Diabetes/chronic kidney disease, then evaluation should be done yearly.  If three or more major risk factors are found then every two years. If one or two major risk factors are there then every three years. If none then every five years.


Factors that lead to CAD


"Women with diabetes mellitus have the same risk of CAD as do men of similar age. The reason for this markedly increased risk may be that diabetes is often associated with obesity and hypertension. Coexistence of hypertension and obesity multiplies this risk 3-fold.  Also, Dyslipidemia is another major factor which occurs especially in older women, who lose the protective higher concentrations of high density lipoprotein cholesterol post menopause. In pre-menopausal women, thyroid disorders also cause dyslipidemia, and may result in higher CAD rates. Smoking is increasing in (especially younger women.) Pre-menopausal smokers have three times the rate of CAD as non-smokers," adds Dr Anil Dhall.


It is not that the disease is increasing in women alone. Overall the prevalence of CAD has increased in India. We are seeing more women with CAD because more are now seeking help, we have better tests to diagnose CAD in women.


Symptoms of CAD in women and silent heart attacks

  • As women grow older they are caught up by other diseases like arthritis or osteoporosis that can obscure CAD symptoms and delay diagnosis. While they may also have chest pain, women have a greater incidence of  abdominal pain, difficulty in breathing (dyspnea), nausea, and fatigue. Women often delay seeking medical treatment for their symptoms; for example, many women  have said they had brief episodes of angina for several years before having an MI (myocardial infarction).
  • Chest pain in women frequently is attributed to other causes, such as anxiety, stress, psychological problems, heartburn, or other non-cardiac conditions. Furthermore,  their symptoms are more likely to have atypical features and are more often attributed to non-cardiac causes - especially in younger women, in whom coronary artery disease is uncommon. 
  • Simple tests like the ECG and stress test like tread mill test (TMT) are not as reliable in the detection of CAD in women, especially those who are at the pre-menopause stage.



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