Fatal myocardial infarction secondary to
atherosclerosis of coronary vessels
Fatal myocardial infarction secondary to
atherosclerosis of coronary vessels:
Cardiovascular disease is the leading
cause of death among women regardless of
race or ethnicity. In
the US it accounts for 500,000 deaths a year death of 1:3 women
.This amounts to more deaths from heart
disease than from stroke lung cancer chronic obstructive pulmonary disease
and breast cancer combined.
A forty
year old women has a life time risk of cardiovascular disease of 32% . The global
burden of CVD is rising rapidly
. Hypertension affects more men
than women till 55 years of
age but after 55 years the
percentage of women rises and after the age of 60 years a majority of women have
stage all hypertension or are on antihypertensive treatment . Estrogen deficiency has been linked to rapid in
cardiovascular disease in women who have undergone natural or surgical menopause.
Every year CVD claims the lives of women more than men. More than 450,000 women succumb to
heart disease annually and 250,000 die of coronary artery disease .Cardiovascular disease
risk increases with
menopause which may be due to metabolic and hormonal changes.
Cardiovascular risk for women
with established hypertension
was even greater . Interestingly the increased cardiovascular risk associated with Prehypertension was greater
than that associated with smoking
reinforcing the need for treatement
of pre hypertension group.
Prehypertension was associated with other
modifiable risk factors ie. high total cholesterol and BMI emphasizing the importance of global risk factor
reduction for prevention of both hypertension ans cardiovascular disease
outcomes. including endothelial dysfunction
increased arterial stiffness activation of rennin angiotensin
aldosterone system, increased salt sensitivity oxidative stress obesity and
genetic factors have been implicated in
the pathogenesis of BP increases that occur after natural
menopause or ovariectomy
Hypertension in Postmeno women:-In general the totality of
evidence suggests that menopause
is accompanied by small NP
increases that may be partially accounted for by increasing age and BMI
as well as concomitant
increase in other
cardiovascular risk factors. Rigorous prospective studies employing state of art techniques of BP
measurement and correction for antihypertensive therapy
may elucidate this relationship
further. The pathophysiology of menopause
related rise in BP
has been inferred elegant
mechanistic studies in animals
and human subjects .
Dyslipidaemia and Heart
attack;National
cholesterol education programme adult
treatment panel guidelines proposed an aggressive management of dyslipidemia both for primary prevention of cardiovascular disease and secondary prevention of cardiovascular events .
Women with had multiple risk factors for MI:-Some women may have 1) obesity 2) HTN 3) low HDL and 4) high TG . The causes of dyslipidemia may be 5) genetic or 6) secondary to thyroid disorder
diabetes or 7) renal disease . HDL levels predict cardiovascular risk in overall population but sometimes especially
in primary dyslipidemia it may
lead to increase the risk of cardiovascular disorders.
Postmeno women and prevention of MI by Gynaecologists :--Are
we failing in our duties?? In this light
it is important that we must
classify the individual patients risk and prevent any cardiovascular problems
This is not only important in
women who go to physicians or the cardiologists
for check up but also for those
who come to the menopause clinic or general OPD for any complaints.
HTN, MI and Sex of the
candidate who suffer from MI at > 50yrs,.:- A greater proportion of women than men
with MI die of sudden cardiac death before reaching hospital 1 and 2/3 of women
with MI never completely recover.
There is an 8-10 year delay in onset of
CAD between men and women all over the
world. Despite this delay
in onset mortality from CAD is
increasing more rapidly in women than in men.
Age & MI:--Aging
remains one of the most
important determinants of post
menopausal hypertension and the growing prevalence of obesity often in conjunction
with lack of physical activity is likely to increase the cardiovascular morbidity
in the next decade.
Currently control of BP in post
menopausal women remains sub optimal worldwide. Efforts are needed to screen and
identify patients Prevention and
awareness should start early in life
than in perimenopause.
The
incidence of cardiovascular disease
increases with age in women as well as men. In women there is an additional
risk due to the menopause consequent to the loss of ovarian function .Postmenopausal
Hormone Treatement offered for
definite indications during the window
of opportunity prevents or at least differs many atheromas in coronary vessels.
But at the same time we must remember that genomic mechanism play an important
role on the vascular endothelium on ion channels and on the rennin angiotensin aldosterone
system. -.
The bad news in the era of HRT : :--Case history :-Not uncommonly
we come across cases in our locality
where a postmeno woman who was
acquainted with us / our family was admitted on the night before with severe first time
chest pain and could not be revived and succumbed to coronary thrombosis
(massive heart attack). Most of us must
have listened to such an unfortunate event may come across every year ,may be
our relatives or residing in our housing complex. On analysis it is thought
retrospectively that the above patients must have been a high risk candidate for coronary
heart disease which remained undiagnosed. Many of such women (those woman who died and was known to
us) had a family history of heart attack .She herself was suffering
from obesity and high cholesterol levels
for which she was careless and
never had check up, didn’t control diet was sedentary and above all never
offered HRT soon after menopause(window of opportunity)..
Good news in the era of HRT :--It is equally true to meet women of
identical age who received HRT with
oestrogen for 5 -7 yrs postemono as soon as she achieved menopauses. It is
probable the timely HRT saved her and she is living a good quality life with
Diet control and exercise. She, at the age of 64 yrs is still vesting Gym every
day in contrast to her friend who died suddenly last night without any
premonitory symptom. It is concluded, therefore that hormone therapy instituted in the first seven
to eight years (in the second Group of women ) after menopause in the might have prevented
atherosclerotic process form
setting in .
.
Before menopause the extent of atherosclerosis in
woman is equivalent to that of a man 10-15 years younger to her. However after menopause the
risk of a fatal myocardial infarction
secondary to atherosclerosis of coronary
vessels doubles. These high rates
of disease amongst women have been shown
to result from a decrease in the estrogen
level with a consequent increase
in the atherogenic risk factors.
There is an increase in the total cholesterol level low density lipoprotein level and lipoprotein a decrease
in the high density lipoprotein level
increased thrombotic tendency
and an occasional development
of insulin resistance .
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