Diseases

Heart Disease Treatment in Women Information

Angioplasty and stents

Angioplasty involves threading a balloon-tipped catheter into an area of atherosclerosis and inflating it to push the atheroma or fatty deposits against the wall of the artery and reopen the vessel. This is also called a percutaneous intervention (PCI) procedure. Usually, a mesh stent is also put in place, providing a scaffold to hold the blood vessel open. Increasingly, stents include medications that slowly release to keep the blood vessel open. Research shows that PCIs may be better option for women (as compared to coronary artery bypass grafts). However, women have smaller vessels that require more skilled placement of stents. Women are at higher risk of restenosis (a recurrent narrowing of the artery following stent placement), but this may be decreasing with use of drug-eluding stents. Women also have higher rates of complications and bleeding during angioplasty.

Coronary artery bypass grafting (CABG)

Coronary artery bypass grafting is a major surgical procedure in which a blocked vessel is circumvented by sewing in a new vessel next to it, usually taken from the saphenous vein of the leg. This procedure is less commonly done in women (more women get PCIs), and when done, women have more complications. It is thought that this increase in risk is due to the smaller vessels, older age, and increased rates of bleeding issues seen among women. Women undergoing these procedures can reduce their risk of complications with proper surgical preparation and enrolling in cardiac rehabilitation programs afterward.

Diet

The classical heart healthy diet is low fat (

Exercise

Almost all women can benefit from increasing the amount of physical activity they get. It is also important to increase the frequency and intensity of exercise. One tool women can use to plan more physical activity is to use the FITT tool, which helps women create an achievable definition for the Frequency, Intensity, Timing, and Type of activity for them. Once activities are selected, women should strive to accumulate at least 150 minutes per week in moderate-intensity exercise.For each unit of increased exercise capacity a woman achieves, she experiences at 17% reduction in CVD mortality. To determine if you have an age-appropriate exercise capacity, first calculate your maximum heart rate. To do this, subtract your age from 220 (for example, the calculation for a 65-year-old woman would be: 220-65=155). You should be able to reach 85% of your predicted maximum heart rate (be sure to warm up first) and recover your breath within 1 minute of stopping. To calculate 85% of your maximum heart rate, multiply your maximum heart rate by 0.85 (for example, 155 x 0.85=132).

Medications for heart disease in women

Aspirin therapy is a simple and beneficial strategy for both men and women with or at risk for heart disease. Aspirin is especially beneficial for women with angina, hypertension, or previous myocardial infarction. Other medications, available by prescription, have only recently been studied in women. Research now shows show that, in some cases, women respond differently than men to prescription medications and thus doctors may need to personalize prescribing for women. For example, women respond less well to the common anticoagulant, warfarin; they have more adverse bleeding events. Women taking warfarin for atrial fibrillation are at a higher risk for having a stroke compared to men. There are other medications, for example:

• Beta blockers: These medications appear to be more helpful for women who have had a heart attack.
• Statins: These medications reduce cholesterol and possibly inflammation and are likely of equal benefit for women and men; however, women have more adverse effects such as myopathy (muscle damage).
• ACE inhibitors: This is a class of medications that cause blood vessels to relax and may confer less benefit for women. Common side effects such as cough and angioedema are more likely in women. However, they may still be appropriate for many women; women should discuss their options with their doctors.

Smoking cessation

Quitting smoking both reduces risk for future coronary events and improves health status in the presence of existing cardiovascular disease. Even small amounts of smoking (1 to 14 cigarettes per day) have a significant negative impact. According to research in the Nurses' Health Study, the benefits of quitting are experienced very quickly. Within 2 years of quitting, cardiovascular risk decreases by one-third. Women continue to benefit for each year they abstain; women who haven't smoked for 20 years are at almost equivalent risk as never-smokers. However, quitting smoking is more difficult for women than for men, according to research, because women report using tobacco to self-treat depression, anxiety, weight, and more. In order for women to be successful, they should seek support to address the risk of weight gain and underlying mood issues.

Stress reduction and depression

Stress is a significant and measurable contributor to heart disease. Stress not only raises blood pressure, it impacts our ability to stick with the healthy lifestyle behaviors that are needed to manage and prevent heart disease. There are clear benefits to engaging in stress reducing activities. For example, a recent study suggests that transcendental meditation may help in secondary prevention of coronary heart disease (preventing a secondary heart attack) and may reduce all cardiovascular events by 48% over a 5-year period. Recommendations for meditation, yoga, and similar approaches have even made it into the American Heart Association's recommendations for blood pressure treatment. For many women, the idea of reducing stress is hard to imagine when the day is already over-full with work, errands, cooking, and taking care of others. While it may seem overwhelming to fit in a separate stress-reducing activity, practices such as mindfulness-based stress reduction (MBSR) are techniques for bring a new perspective and enhanced calmness into day-to-day activities. Studies have demonstrated improvement in stroke recovery with MBSR as well as blood pressure reductions. Mindfulness programs are readily available in many communities. Screening for and treating depression is also an important part of treating heart disease in women. Women suffer from depression more often than men. Questionnaires like the PHQ-8 can help women and their doctors identify depression quickly. A similar screener is available at Mental Health America. Treatment options such as cognitive behavioral therapy (CBT) and mindfulness training are as effective as antidepressant medication and may have beneficial effects in stress reduction, too.

Weight management

Weight management is especially important because 2 out of 3 women in the United States are overweight or obese. Excess body weight directly increases CVD risk and also leads to a number of conditions that indirectly increase the risk of a heart attack such as diabetes and hypertension. When women adopt healthier lifestyle practices and reduce weight, they immediately reduce the risk of developing more significant heart disease. A recent study showed that women who lost just 10 percent of their body weight and kept it off for 2 years reduced their cholesterol, triglycerides, insulin, glucose, and inflammation markers. Women who had the highest levels of risk at the start of the study benefitted the most from modest weight loss.