No Longer a "Man's" Disease

Changing Demographics: The Aging Population

Until recently, popular media has portrayed cardiovascular disease (CVD) as a “man’s disease.” In fact, CVD, which includes coronary heart disease, high blood pressure and stroke, is the leading cause of death among American women, responsible for 38 percent of all female deaths.5 The percentage of deaths due to CVD among women aged 60 and older in developed countries has been reported to be even higher at 59 percent, compared to 50 percent for their male counterparts.6 Of female heart attack victims, 60 percent die suddenly and an alarming 46 percent of survivors will be disabled by heart failure within six years.7

The historical focus on CVD in males has clouded some fundamental gender differences related to its presentation, diagnosis and treatment. Women biologically have smaller hearts than men, making diagnosis and treatments more difficult.7 Women also often present with different symptoms, including shortness of breath, unusual fatigue, indigestion, anxiety, sleep disturbance and chest pain characterized as “aching or tight” rather than “crushing.”8 These signs may be mistaken for panic disorder or stress and lead to mistreatment of the condition. Heart disease in women also tends to be diagnosed later in life, when estrogen production has faded, and therefore treatment may be less aggressive due to age.7

Risk Factors, Prevention & Treatment

Fortunately, many risk factors for CVD can be controlled. High blood pressure, elevated total cholesterol and triglycerides and low HDL (good cholesterol) increase the risk of death in women over the age of 65.9 Diabetes and a family history of heart disease further contribute to the risk.9 Smoking, even as few as one-to-four cigarettes a day, doubles the chance of having a heart attack.10

Figure 2: Cardiovascular Disease in Women

CARDIOVASCULAR DISEASE IN WOMEN

Lifestyle changes aimed at decreasing risk, such as reducing stress, increasing physical activity and eating a healthy diet, have been reported to reduce the risk of a heart attack by more than 80 percent.11 In February 2007, new guidelines were published by the American Heart Association to help decrease the lifetime risk of dying of CVD for women.12 The recommendations included alcohol consumption in moderation, smoking cessation and weight control, including the reduction of saturated fats and increased dietary intake of fresh fruits, vegetables and low-fat dairy products. Routine use of low-dose aspirin is also now considered for women over the age of 65, regardless of their cardiovascular risk status. Medications are often used when lifestyle changes are not adequate to reduce the risk, such as: angiotensin-converting enzyme (ACE) inhibitors (Zestril, Vasotec and Prinivil) that reduce blood pressure by inhibiting the formation of angiotensin II, calcium channel blockers (Calan, Procardia, Cardizem) to increase blood flow to the heart muscle by dilating coronary arteries and statins (Lipitor, Zocor) that block an enzyme (HMG-CoA) needed to produce cholesterol. Anti-hypertensives are another type of medication frequently used to reduce blood pressure.

Oral Connections

The most evident oral connection relates to side effects commonly associated with medications for cardiovascular disease.13 Patients taking these medications may experience xerostomia, gingival hyperplasia and/or taste impairment. It is critical for dental professionals to understand the potential linkage between periodontal disease and cardiovascular disease as well as recognize the profound implications on patient care. Recent literature reports indicate that periodontal disease may increase the progression of cardiovascular disease.14 Experts believe the association is related to oral bacteria and the resulting inflammatory process. Local oral inflammation created by specific bacteria destroys gingival tissues and the host responses trigger ruptures of atherosclerotic plaque. While the exact nature of the relationship has not been definitively established, numerous reports in leading medical and dental journals substantiate a link.15-18