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Forum Name: Ischemic Heart Disease

Question: Why are Young Females Naturally Protected from Heart Disease


 Rosemary349 - Thu Nov 19, 2009 7:56 am

Hi

I've read in many places that young females are naturally protected from heart disease. Does that mean young men are not?

How does it work? What does the young female body do to fatty deposits in the arteries? Does it clear them more efficiently or does the laying down of deposits not happen so much? I'm very interested in the mechanism involved.

As i'm 39 what can I do to try to keep that protection as i get older? Does HRT help maintain that protection? My mother started her menopause at 39........I don't think i've started mine yet but i am thinking ahead because my father has just died suddenly at 64 with an acute ruptured MI (you will see about this in another post).

In the last year i've noticed a lot of irregular heartbeats. I've had a normal stress test recently, BP is 120/80, cholesterol was good apparently (inc the good cholesterol)....and i had a 24 hour monitor that was apparently normal (haven't seen the results for myself)......unfortunately those irregular beats did not occur when i was wearing the monitor.

I've wondered if the irregular beats have started up since trying to wean myself off Zopiclone (i've been taking it for about 7 years!!! i know! but a very stressful environment for sleeping mean't that my doctor allowed this, it was the lesser of two evils and now he's trying to get me off the drug). I'm now down to half of the drug per night but the other night i lowered the dose further and the next day i had a funny quivering feeling in the back of my throat - involuntary. The next morning i noticed two bruises on my tongue! They would only have occured if i had bitten hard on my tongue i think.....worrying me as to whether i will have a seizure if i lower the dose further.

I have been constantly at my doctors recently because of anxieties about my own heart since my dad died. I'm embarassed to keep going to them so haven't told them about this.

Thanks for listening. Any advice would be appreciated. It would be great to understand how females are protected too. Is there no way that protection could be transferred to men medically? Sorry if that's a silly question.
 John Kenyon, CNA - Mon Nov 30, 2009 10:59 pm

User avatar Hello there -- I replied to your post regarding your dad's MI. I hope that was helpful and that this will be also. The reason young women (actually premenopausal women, who in reality are quite young now, since the whole age paradigm has changed) are protected from heart disease, or at least enjoy a layer of protection men do not, is estrogen. This is a known protective counter-risk factor for women prior to menopause. Men simply don't get this one. I wish we did!

HRT has become controversial in recent years, since it both confers continued protection against heart disease but may also (depending upon which studies you choose) my confer risk factors for other non heart-related problems such as certain cancers.

In all people the best protections, long-term, against heart disease, are a good family history and a healthy lifestyle (primarily diet and exercise), along with regular checkups that include blood lipid measurement and c-reactive protein measurement annually. If either is abnormal, medical management of the lipids should be begun promptly and aggressively. Also, of course,there is the issue of smoking, which is a separate, controllable risk factor.

Your dad having died of an MI (a fairly unusual complication was involved as you know) may or may not count as positive family history, depending upon what his cholesteral levels had been (if known) and if he was considered to have premature coronary artery disease. Unfortunately, this is often something impossible to know when the person in question appeared healthy and had no special reason to have these items checked on a regular basis. For this reason it's especially important for you to know what your other, personal, risk factors are, what your cholesterol level is and the breakdown of the various contributing lipids; also that you live healthy, maintain a healthy body weight, and in general do all the prudent things to avoid potential heart disease. C-reactive protein (CRP) is one indicator, as is cholesterol. Very high cholesterol levels would suggest a genetic problem. Luckily this can be attacked medically with anti-cholesterol drugs. In fact, with a positive family history the main difference from someone without that factor, is simply being more aggressive in maintaining a healthy lifestyle including regular exercise.

Your dad's tragic coronary event took place at an age where we do start to see a lot of heart disease and MIs. While he was still pretty young -- and now would be considered a young man having had an MI -- he was approaching the statistical area where it's not too surprising to see heart disease. The fact his first known event was a fatal one is terrible, but again, was a rather unsual outcome, not something which in itself is a heritable syndrome. Heart disease can be, but the particular chain of events in his case was just really horrible luck.

The premature heartbeats you're currently feeling (palpitations) are normal and common in the healthy population as well as in those with heart disease, so are of no diagnostic nor prognostic significance. However, they do occur more often in people who suffer from anxiety. We discussed this in your other post, and it's unsurprising you would currently be feeling more of these and perhaps noticing them for the first time. Again, to ease your mind and clear the air, a comprehensive cardiological workup should be done for you, just as a baseline for future reference. We all could benefit from that sort of information being on file. In your case it could also either expose a familial tendency to heart disease (but not to the specific event your father suffered) or it could totally let you off the hook in that regard.

Once a woman has passed through menopause, she is then on an equal footing with men re: heart disease, except that HRT may be considered. While this is not currently offered to men because there's been no clear advantage demonstrated, research continues for both genders. Meanwhile, the best way to avoid problems, again, remains living a healthy lifestyle and keeping those annual appointments just to keep an eye on things.

Oh, and the likely bitten tongue was probably just that. With intense anxiety often there are nocturnal things that turn up that hadn't happened before and this is one we see. I'd refer you back to my response to your other post and the suggestion to consider counseling and CBT to help you work through the emotional trauma you experienced. This could, in the short run, improve your quality of life a great deal, even as you begin to take all the standard precautions we need to in order to avoid heart disease, even if there is no family predisposition.

I do hope this is helpfful. Again, my best to you and of course please stay in touch with us here.

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