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Know your risk

Dr Angela Maas, a world-renowned expert in female cardiology, looks at the main risk factors for cardiovascular disease affecting women

Prevention is the cornerstone for avoiding cardiovascular disease, but nothing is as difficult as leading a healthy life. The temptations for unhealthy behaviour are manifold in our society and it requires a lot of discipline to resist these. But it pays off: in women more than men it has been shown that heart attacks, heart failure and strokes can be prevented with a healthy lifestyle and by treating risk factors properly.


Before the menopause, women have pear-shaped fat distribution, with most fat around the hips. After the menopause, more fat develops in the stomach and the apple shape begins to dominate. This increase in stomach fat is disadvantageous with regard to the risk of developing cardiovascular disease because it stimulates inflammatory reactions and atherosclerosis. It also has a negative effect on glucose (sugar) regulation, resulting in a higher risk of metabolic disorders such as diabetes and high blood pressure. That’s why there’s a growing body of opinion that regards obesity not as flawed behaviour, but rather as a serious disease. What’s more, being overweight is also a risk factor for various cancers, including breast cancer, particularly if there are metabolic disorders.


Women who smoke have early signs of vascular ageing: more than two-thirds of heart attacks in women below the age of 55 are related to smoking and this also applies to strokes, Transient Ischemic Attacks (TIAs, a stroke with recovery) and vascular problems in the legs. At a young age especially, women who smoke are twice as likely to have a heart attack as men. Smoking accelerates the first signs of atherosclerosis, including in women who have not yet reached the menopause; it stimulates inflammatory responses in the body and activates the coagulation system. Women who smoke reach the menopause on average two years earlier than those who don’t, and this also contributes to the increased risk of developing vascular problems at a young age. Giving up smoking increases your life expectancy, irrespective of age, sex and the number of cigarettes smoked per day.


Where cardiovascular disease is concerned, stress and emotional problems such as anxiety and depression are equally powerful risk factors as high blood pressure and cholesterol, and the significance of this in our society is growing. Stress causes a fast heart rate and activates the hormonal system in the adrenal glands as well as the coagulation and immune systems in our bodies. Stress is experienced differently by each and every one of us. Men and women vary in the way they deal with stress and other psychosocial problems, which means that the impact of contracting cardiovascular disease is different. In recent years, we have increasingly encountered particular types of heart attacks in women where stress-related factors played a major role.


Traditionally, many beneficial effects have been ascribed to alcohol where our cardiovascular system is concerned: it was said to be good for your cholesterol, coagulation and metabolism of the vascular wall. The polyphenols in red wine especially, such as resveratrol, were alleged to have a powerful protective effect on the vascular wall and slow down the process of atherosclerosis. More recent publications are much more negative and show that the less alcohol you drink, the lower the risk of cardiovascular disease and various types of cancer. In the UK, the NHS advises that men and women should not drink more than 14 units a week, but it should be noted that alcohol metabolism is different in men and women – women absorb 30 per cent more alcohol in their bloodstream than men.


For many years, numerous positive features have been attributed to the Mediterranean diet which includes a great deal of olive oil, fruit, nuts, vegetables and grains, with a moderate amount of fish and poultry and little dairy, red meat and sweet things. For most people, drinking a daily glass of wine as part of a Mediterranean diet is fine. Studies have shown that this kind of diet gives a 30 per cent reduction in cardiovascular disease for people who have an increased risk. The big supermarket chains should play a more major role in steering their customers toward healthier food. Research has shown that this works. Soft drinks and power drinks contain a lot of sugar and calories and are linked to a higher risk of cardiovascular disease. This is partly connected to other unhealthy behaviours on the part of many consumers.

Raised cholesterol

In cardiology, it’s standard practice for us to measure four fat levels in the blood: total cholesterol (TChol), good cholesterol (HDL), bad cholesterol (LDL) and triglycerides (TG). Then there is the ratio; this is the value of TChol divided by HDL. To keep it simple, you can use the 5-rule for normal levels in healthy people: TChol less than 5mmol/L; TChol/HDL-ratio less than 4; LDL less than 3; TG less than 2 and HDL greater than 1.

For women with mild raised cholesterol and a lower risk of cardiovascular disease, red yeast rice preparation may offer a solution, although studies into it are limited and there is little research into its longterm benefits and safety. Red yeast rice contains monacolin K, which is identical to the statin lovastatin. When taken daily TChol and LDL values drop by 0.7 to 1.5mmol/L (27 to 58mg/dL).107 Because monacolin K is in fact a statin it can cause similar side-effects, although patients report these much less often as most types of red yeast rice also contain Q10. These days, there are a number of reputable brands of red yeast rice with safe and traceable production processes on the market, but it should only be used under the guidance of a healthcare professional. Red yeast rice supplements that also contain berberine, a substance which removes additional LDL from the blood, appear to be most effective in lowering cholesterol values.

Extracted from A Woman’s Heart: Why Female Heart Health Really Matters by Dr Angela Maas, published by Aster, £9.99,

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