Currie.qxp 30/7/08 3:39 pm Page 18
Disease Risk Management
cholesterol, with, in particular, an increase in low-density lipoprotein
Figure 1: Causes of Death in European Women
(LDL), lipoprotein-α and triglycerides and a decrease in high-density
lipoprotein (HDL).
7–9
Therefore, menopausal women are exposed to a
4% 6%
more atherogenic lipid profile than pre-menopausal women. Total
16%
cholesterol levels peak in women at 55–65 years of age – about 10 years
57%
later than the peak in men (see Figure 3).
Agents that lower cholesterol levels reduce heart disease risk in both
men and women, but it is thought that a larger proportion of women
than men are at high risk and are not being effectively treated. It was
shown in a recent survey that only one in four women associates
17%
menopause with high cholesterol, leading to a lack of awareness of
the need to consider having cholesterol level checked around the time
of the menopause.
5
Cardiovascular disease Injuries and poisoning Respiratory diseases
Cancers (breast, lung, stomach, colorectal and others) Other cause
Smoking
Tobacco use is one of the most important risk factors for CVD in both
men and women, although the risks associated with smoking are
Source: World Health Organization, 2004.
2
consistently higher in women than in men. Although in general more
Figure 2: Percentage of Population Affected by Cardiovascular
men than women smoke, the important and encouraging decline in
Disease with Increasing Age
tobacco use among men is worryingly less apparent in women, while
there is a disturbing rising trend in younger women.
60
Diabetes
50
Diabetes is becoming increasingly common in both men and women, and
changes in insulin secretion and insulin sensitivity after the menopause
40
contribute to this increase in women. The risk of death from CVD
associated with diabetes is higher in women than in men: in the 20-year
%
30
Framingham study, women with diabetes were 3.3 times more likely to
die from CVD than women without diabetes, whereas the risk for 20
diabetic men was only 1.7 times that of non-diabetic men.
10
10
The increase in these risk factors leads to a four-fold increased risk in CVD
in women in the 10 years after the menopause.
11
The belief that this
0
20–34 35–44 45–54 55–64
increase is menopause- or oestrogen-deficiency-related rather than Age (years)
purely age-related is confirmed by the findings that for post-menopausal
Men Women
women at any age there is an increased risk of CVD (see Figure 4).
Figure 3: High Cholesterol Levels for Men and Women in
England, 2003
Other Problems
Symptoms of heart disease manifest themselves differently in women
90
and in men, with women being less likely to present with classic, well
80
recognised cardiovascular symptoms.
7
Angina can be mistaken for
70
indigestion or heartburn, and symptoms of myocardial infarction (MI)
60
can include overwhelming fatigue, shortness of breath, nausea or
%
50

indigestion. Women therefore tend to present late in the disease 40
process, by which time they may also have other medical conditions that 30
may affect the prognosis. Furthermore, it is recognised that women are
20
less likely to be offered intervention, and traditionally have been poorly
10
represented in clinical trials. Not surprisingly, then, women have a worse
0
prognosis following an MI than men: in US patients diagnosed with
16–24 25–34 35–44 45–54 55–64 65–74 ≥75
Age (years)
acute MI, 38% of women but only 25% of men die within a year. Men Women
Within six years of a first MI, 35% of women but only 18% of men will
have another MI.
12 Percentage of adults with blood cholesterol levels ≥5.0mmol/l in England, 2003.
Management of Cardiovascular Disease Risk at Menopause estimated by the World Health Organization (WHO) that 80% of CVD can
With the onset of menopausal symptoms, women and their doctors and be prevented by diet and lifestyle changes and, indeed, a recent European
nurses should not only discuss the symptoms, but also think long-term and survey showed that 73% of respondents said that they would prefer to
consider risk factors for both bone health and heart health. It has been deal with menopausal symptoms by having the right diet and lifestyle.
6,13
18 EUROPEAN CARDIOLOGY
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