Heart attacks: Older women with clogged arteries need better treatment

  • Atherosclerosis is a condition in which the arteries narrow due to a sticky buildup of plaque deposits.
  • Researchers say women over the age of 55 with this condition are at a higher risk of a cardiovascular event such as a heart attack than men in the same age group.
  • Experts say women of all ages can improve their cardiovascular health by maintaining healthy blood pressure and cholesterol levels as well as by not smoking.

Postmenopausal women who have clogged arteries are at higher risk of heart attack than men who are the same age.

That’s according to research being presented at the scientific congress of the European Society of Cardiology that was published recently in the European Heart Journal – Cardiovascular Imaging.

In their study, researchers said they found that having plaque is more dangerous in women who are postmenopausal compared to men of the same age.

“The study suggests that a given burden of atherosclerosis is riskier in postmenopausal women than it is in men of that age,” Dr. Sophie van Rosendael, an author of the study and a researcher at Leiden University Medical Center in The Netherlands said, in a press statement.

“Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment,” she added. “Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug. More studies are needed to confirm these findings.”

Details from the women’s hardened artery study

The study involved nearly 25,000 people across six countries in North America, Europe, and Asia.

An imaging technique called coronary computed tomography angiography (CCTA) was used to capture 3D images of the arteries in the heart.

Atherosclerosis is when the arteries narrow due to a build of sticky deposits of plaque.

In the United States, it’s estimated that about half of people between the ages of 45 and 84 have atherosclerosis and don’t know it. Heart disease—which is associated with atherosclerosis— is the leading cause of death in the United States.

The researchers examined whether the presence of atherosclerosis had the same importance in prognosis for men and women of the same age.

They reported that there was a 12-year delay in the onset of coronary atherosclerosis in women.

The presence of plaque was found to be equally predictive of a major adverse cardiovascular event in men and women aged under 55.

However, in women who were 55 and older and in the postmenopausal group, the risk of an adverse cardiovascular event was higher than in men in the same age group.

Among postmenopausal women, those with a medium or high plaque burden had a 2.21 to 6.11-fold higher risk of a major adverse cardiovascular event.

“In this study, the elevated risk for women versus men was especially observed in postmenopausal women. This could be partly because the inner diameter of coronary arteries is smaller in women, meaning that the same amount of plaque could have a larger impact on blood flow,” van Rosendael said.

“Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared to men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment,” she added.

Women and heart disease

Dr. Abha Khandelwal, a clinical associate professor of cardiovascular medicine at Stanford University in California, not involved in the study, said these findings aren’t surprising.

“Clinically, what we see is there’s a whole host of changes that occur around menopause and several of them are significantly impactful to the cardiometabolic status of a woman. So. it is very common that women will have derangements in their blood pressure, blood sugar, cholesterol, weight, all around the time of menopause. So I always ask my patients to be reassessed around that time,” she told Medical News Today.

“In menopause, specifically, women go through not only a lot of cardiometabolic changes, they go through a lot of emotional changes, rates of depression can go up, sleep is disrupted. All these things we know when they’re left untreated can influence cardiac outcomes,” Khandelwal added.

Lifestyle choices can help reduce heart disease risk

Experts say there are a number of steps women can take even before menopause to help protect their cardiovascular health.

“At all ages of life, there’s an opportunity for each patient to work with her doctor to maximize a healthy lifestyle, to screen for atherosclerosis, or this sticky plaque build up, to screen for the risk factors that cause atherosclerosis, which include high blood pressure, high cholesterol, diabetes, smoking, family history, vasculitis or inflammation of the blood vessels, certain autoimmune conditions and others and then treat these proactively,” Dr. Sarina van der Zee, a cardiac electrophysiologist and cardiologist at Providence Saint John’s Health Center in California, told Medical News Today.

“So absolutely there are preventative options that a woman with her doctor can identify, treat upstream and prevent from coming becoming an issue. This is especially important after menopause, but certainly is an important process to start even beforehand, if possible,” she added.

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