Introduction Coronary heart diseas...

Introduction

Coronary heart disease (CHD) remains the leading cause of death for women in the United States.1,2 Endogenous estrogen is speculated to provide a protective efficiency for premenopausal women against coronary disease; however, this advantage for women diminishes with age and menopause.3 single in kind in 9 women aged 45-64 years has demonstrated clinical evidence of coronary disease; this rate increases to 1 in 3 for women older than 652 In general, women lay open CHD 10 years later than men; however, CHD involves a worse prognosis for females, the two in terms of an increased morbidity and mortality rate with myocardial infarction,4-6 and with les fortunate surgical revascularization.6-8

CHD Prevention

Risk factors for the growth of atherosclerosis and CHD have been well documented, the pair from a historical and from a contemporary perspective. They have been described with of that kind terms as modifiable or nonmodifiable, major versus minor, contributing factors, and as emerging or novel.9-12 The modifiable risk factors have included cigarette smoking (tobacco smoke) hypertension, elevated cholesterol diabetes, sedentary lifestyle, obesity, and stres The nonmodifiable risk factors have included family history, age, inflection for sex and ethnicity. Contributing factors have been listed as stres rejoinder excess intake of alcohol, peripheral vascular disease, and sex hormones,9 which also include hormone replacement therapies and oral contraceptive agents. The emerging or novel risk factors have been documented to include lipoprotein (a), homocysteine, small thick LDL, inflammation and infection, hemostatic factors as it was as fibrinogen levels, and iron stores.12

Under the auspices of CHD prevention, it is essential to exclusively consider modifiable risk factors in women With regard to cigarette smoking, smoking rates have been shown to be declining les for women than for men in latter years.13 As cigarette smoking is considered a primary causal factor in approximately 30% of all coronary heart disease-related deaths,14 this risk factor iri women emphasizes the importance of smoking cessation programs and educational strategies to convert into the incidence of smoking in women

Hypertension is known to be single of the most prevalent diseases in the United States, predisposing to an increased risk for cerebrovascular disease and CHD6 Although highly public in both genders, it has been estimated that approximately 52% of women through the age of 45 years have elevated family pressure.17 Estrogen appears to play an antagonistic part in the development of elevate progeny pressure.16 In general, it appears possible that the older a women is before she chronicles menopause, the less likely she is to die from cardiovascular disease. Natural estrogen may have a more protective power against forms of cardiovascular disease than synthetic forms. Propos mechanisms of action of estrogen have included, on the contrary are not limited to vasodilation mechanisms, favorable purports on hemostatic factors, favorable lipid alterations and possible antioxidant properties.16,19 It has been hypothesized that diabetes greatly increases the risk for CHD in women as compared to men220 Diabetes has been postulated to be associated with altered lipid profiles in the same state [i]or[/i] condition as low values of HDL-C (high density lipoprotein cholesterol) and high values of TG (triglycerides).21 In addition, diabetes has been associated with the unfolding of hypertension.22 Certainly, adult-onset (Type 2) diabetes appears later in life and may predispose the postmenopausal woman to an increased risk for CHD

Along with the multifactorial influences of additional risk factors as it is as obesity and lack of physical activity, special emphasis must be placed in succession diabetes by clinicians with regard to a holistic approach to women's health.

In fresh years, as focused attention has been given to the practice and cogitation of risk factor reduction as a means of CHD prevention, management of dyslipidemia between the walls of the use of diet, exercise, and medication, has largely been viewed as the basis for primary and secondary prevention of CHD Numerous studies have used lipid-lowering agents in primary and secondary intervention trials,"" and favorable follows have been noted, although many of these initial trials primarily involved men26-2932-35 Nonpharmacologic strategies have additionally been examined as mechanisms to assist with risk factor reduction and ultimately CHD prevention. Maintaining a physically active lifestyle has been commonly associated with a more favorable lipid profile and a reduc risk of CHD3637; while secondary prevention of CHD [i]or[/i] part of to the other various exercise programming has also been substantiated.38-40 Nonpharmacologic prevention strategies in women have freshly become more specifically addressed.41 43

This inflection for sex disparity appears somewhat paradoxical given that approximately 40% of women greater than 55 years of age have elevated serum cholesterol values.15 Baseline LDL-C (low density lipoprotein cholesterol) values of les than 100 mg/dL (as by National Cholesterol Education Program recommendations) were plant in only 10% of those women with known CHD recorded in the HERS (Heart and Estrogen/progestin Replacement Study)44 Certainly, these nonfavorable lipid profiles appear to involve postmenopausal women to a greater compass and hormone replacement therapies continue to qualified mixed reviews in terms of their favorable effectiveness with regard to the life-current lipid profile.45-48