Heart Disease Risk Rises After Menopause

Sep. 14, 2008 -- No one knows why so many women have heart disease symptoms that are different from those of men, but one clear risk factor is the time after midlife.

"Coronary artery disease becomes very significant after menopause," said Dr. Chad Hoyt, a Lynchburg, Virginia, specialist in heart disease. "We have to be diligent about being thorough."

Every woman should know her coronary risk factors, he said -- those include blood pressure, blood sugar levels that indicate diabetes, level of exercise, body weight and cholesterol levels.

"Those are traditional," he said. They do help predict disease, but "because you have risk factors doesn't mean you have the disease."

Similarly, it doesn't mean coronary artery disease is not present if the risk factors are absent and the woman has no symptoms.

Coronary heart disease is a leading cause of death in the U.S. among women, killing more than 230,000 women each year.

Methods are available to test women for heart disease that don't involve invasive techniques but still are extremely accurate.

Hoyt said that a noninvasive screening called a calcium-scoring test uses a CT scan that detects calcium in the coronary arteries and uses software for evaluation.

If there's no calcium in the arteries, then chances of heart disease are very low, he said. If there's a lot of calcium, the likelihood increases substantially.

Calcium scoring relies on a correlation between the presence of calcium and the amount of plaque in the arteries. A person with a high calcium score can be without symptoms, but the disease is then recognized.

Screening is a way of evaluating apparently healthy people for an unseen risk. Most women over 40 are familiar with routine screening mammography, which is done to see if cancer is present and not because a symptom of cancer has triggered the need for a diagnostic test.

Within the next 12 months, said Hoyt, a large calcium-scoring clinical trial likely will be rolled out, in which Centra would participate, and that could mean a cost break for patients.

Centra can do the test, and some insurers cover it under some conditions.

Hoyt cautioned that women should not consider calcium intake as posing a risk factor -- many women take additional calcium to help prevent thinning bones. Hoyt said there is no relationship between calcium intake and calcium within the arterial plaques.

When plaque accumulates in the arteries, it calcifies over time, he said. "All women should know their risk factors. If they have them, they should be screened and calcium scoring is the best way out there."

One of the advantages of the calcium-scoring test is that it has no false positives, which is a problem with women and the traditional treadmill stress testing.

Changes on the EKG during the treadmill test can make it seem like a blockage is present, when it's not.

When imaging is added to the treadmill test, accuracy improves, he said. "I'd rather have a test that overcalls, than to miss it. We're screening for coronary artery disease -- a lethal disease."

If women have symptoms that are worrying them, he said, they need to talk to their family doctor and have one of the non-invasive tests done.

Hoyt said the Lynchburg cardiologists are working with others in the medical community to provide clinical guidelines for evaluating symptoms of coronary artery disease for low and intermediate risk. Critical pathways for decision-making, lectures and community presentations are also part of the effort. "We've really tried to blanket the medical community," he said.

Also in the works at Lynchburg General is a Chest Pain Center to which patients experiencing chest pain and coming to the Emergency Department can be referred to the clinic by the ED doctors.

"We want to provide the best diagnostic workup at the lowest cost and improve the level of care," he said.

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