Women and Peripheral Vascular Disease (PVD)
Women's Heart Health
MADISON - Across the country, women having hot flashes are searching for a cool breeze. Could estrogen be making a comeback in this arena?
When the results of the Women's Heart Initiative (WHI)
and the Heart Estrogen/Progestin Replacement Study (HERS) several years ago revealed an increased risk of vascular events in women on hormone replacement, estrogen quickly fell out of favor as a treatment for peri-menopausal symptoms.
Estrogen Revisited, Again
Various studies since then, however, have noted improvement in certain vascular beds for women on hormonal therapy.
For example, several observational studies reported less frequent carotid atherosclerosis (hardening of the arteries), as assessed by ultrasound, in women taking postmenopausal hormone therapy. Randomized trials in response to the controversy have provided differing results. Some looked at the results from a patient perspective - did women with certain risk factors fare worse compared to others?
The studies showed that those with cardiac disease already did worse. Would starting hormonal therapy earlier in the process prove beneficial? How close is the estrogen given in a pill to the endogenous estrogen made by the ovaries? Does the addition of progesterone make a difference?
The most recent analyses report that for the most part, among generally healthy postmenopausal women, conjugated estrogens with progestin did not give protection against peripheral artery disease.
"Not all have given up among the scientists and the women, however. Stay tuned," says Karen Moncher, MD
, a UW Health Heart and Vascular Care physician.
Vascular Diseases in Women
It is estimated that more than 20 million Americans are at risk of developing non-cardiac arterial disease. These conditions may lead to stroke due to carotid artery blockages, amputations due to leg artery blockages and aneurysm ruptures from ballooning of the aorta.
Women diagnosed with vascular disease generally have advanced stages. They tend to be elderly with several other serious medical conditions.
"Women with peripheral arterial disease have a two- to four-fold increase in cardiovascular disease and disability," says Tefera. "This makes early screening, combined with risk factor reduction, critical in prevention and control of vascular disease in women."
Some of the most important facts and risk factors include:
Smoking is strongly associated with vascular disease in men as well as women. The incidence of vascular disease is 3 times higher in smokers than none smokers.
- Hyperlipidemia (High Blood Cholesterol and Triglycerides)
A 10 percent decrease in total cholesterol levels may reduce the incidence of coronary heart disease by approximately 30 percent. In 2003, nearly 100 million people were told they had total blood cholesterol levels of 200 mg/dl or higher. Over 80 percent of people with high blood cholesterol do not have it under control.
The incidence of vascular disease in diabetics is at least twice as high as in non-diabetic patients.
Incidence of vascular disease in women is greatest after age 65. It is estimated that at age 40 the incidence is three to four percent, while at age 80 this increases to 15-30 percent.
During menopause, there seems to be an acceleration of atherosclerosis (hardening of the arteries), and hormonal replacements are usually not protective against vascular disease.
UW Health Heart and Vascular Care services provide a multidisciplinary approach to the screening as well as treatment of vascular diseases.
"Early screening may lead to recognition and early intervention on some of these vascular diseases that may have huge impact in patients' quality of life," Tefera says.
Date Published: 12/05/2007