Even though women tend to perceive cancer as their biggest health threat, heart disease is the leading cause of death for women across most races in the United States. (The exception is among Asian American women, where heart disease is second to cancer.) According to the Centers for Disease Control and Prevention, in 2005 in the US approximately 864,500 people died from cardiovascular disease, which includes diseases of the heart and blood vessels. Of that total, approximately 454,600 (more than 52%!) were women. Clearly, the common misconception that heart disease is primarily a man’s disease is simply not true.

Heart Health Differences between Men and Women

There are, however, significant differences between men and women when it comes to heart disease. For one thing, research that focuses on heart disease in women is years behind the research into the same disease in men.

Fortunately, research into women’s heart health is gaining ground, and what we’ve learned about the differences —between men and women, as well as between younger women and older women— benefits everyone, men and women alike.

One primary difference is that heart disease typically occurs later in life in women, and usually after menopause. Yet young, premenopausal women who do have a heart attack are more likely to die from it than are men of the same age, even when they have few risk factors. In general, women are less likely to survive their first heart attack and, if they do, are more likely to have another heart attack within a year.

Women also tend to exhibit less specific symptoms than men before a heart attack. For example, women might notice indigestion, muscle weakness, unusual fatigue or sleep problems rather than the chest pains that men typically report. Many menopausal women experience heart palpitations and go to the emergency room thinking they may be having a heart attack, only to find out they are OK and that the palpitations are probably due to changes in their hormone levels. These nebulous and potentially confusing types of symptoms don’t usually trigger thoughts of cardiovascular disease in most women, but they should be reported to your practitioner as a precaution. It is never too late—or too early—to begin taking better care of your heart.

Hormones and Heart Health

As researchers try to determine the reasons for the various differences between men and women as they relate to heart disease, their attentions naturally turn to hormones as a major factor. Initially, the estrogen hormones were believed to be the primary source of women’s added protection against heart disease because it is known to decrease levels of low-density lipoprotein (LDL, typically called the “bad” cholesterol) and raise high-density lipoprotein (HDL, known as the “good” cholesterol). The LDL cholesterol is considered bad because it carries most of the fat through the blood vessels where it can be deposited to form plaque within and along the walls of arteries (atherosclerosis). The HDL cholesterol is considered good because it helps to reduce the deposit of this plaque. (See What About Cholesterol?)

But publicity surrounding the national Women’s Health Initiative (WHI) muddied the waters regarding hormone therapy. The WHI participants who were taking Prempro (a combination of Premarin, which is conjugated estrogens made from the urine of pregnant horses, and Provera, a synthetic progestin replacement for the progesterone hormone) exhibited a slightly higher risk of heart attacks, stroke, blood clots and breast cancer than those who did not take it. Hence, the researchers stopped this portion of the study, to much public alarm.

One extremely unfortunate fallout from the WHI results has been a general (misguided) wariness of all hormone therapies, regardless of their composition, dosage or purpose. However, it also provides us with an opportunity to reemphasize how important hormones are to the normal functioning of a healthy body, and to clarify the differences between bioidentical hormones and those that are not. It is important to remember that the hormones used in the WHI study were not bioidentical and, as such, they are known to have different or unintended effects than those that are found naturally in the human body.

Estrogen

Approximately one in every 10 American women between the ages of 45 and 64 years of age has some form of heart disease, and this statistic increases to one in five after age 65. This significant rise in heart disease is believed to be at least partially due to the reduced estrogen levels women experience as they go through menopause. As women’s estrogen production dwindles, their risk of heart disease rises dramatically, eventually becoming the same as men’s risk.

Because women tend to develop heart disease later in life than men, they also tend to have a longer exposure to high cholesterol levels and a thicker buildup of plaque in their blood vessels when their heart disease hits.

Estrogen therapy lowers cardiovascular risk, according to Dr. Jonathan Wright. As stated earlier, it seems to increase blood levels of “good” HDL cholesterol and decrease levels of “bad” LDL cholesterol. However, estrogen is often prescribed as Prempro, in combination with progestin (medroxyprogesterone acetate or MPA), as referenced in the WHI study above. Studies have consistently shown that estrogen alone is more effective in increasing HDL than when combined with progestin.

Progesterone

In Commonsense Guide to a Healthy Heart, Dr. John Lee argues that supplements of bioidentical progesterone (i.e., not progestin) may be more critical for heart health among perimenopausal women than estrogen. He says that “Postmenopausal women with sufficient body fat produce estrogen sufficient for all known body functions excluding pregnancy. The fall in estrogen levels is negligible compared to the almost complete absence of progesterone which commonly begins to fall ten years or so before actual menopause.”

Progesterone protects the heart in many ways, including its ability to reduce high blood pressure. For example, during pregnancy, the high levels of progesterone protect against constriction of blood vessels. Hyperactivity of the blood vessels, which can lead to pain and the development of strokes, is one aspect of cardiovascular disease that is frequently overlooked.

However, Dr. Lee is adamant that the effects of bioidentical progesterone and the more common progestin (medroxyprogesterone acetate or MPA) on the heart and blood vessels are very different. He states that “MPA is a synthetic (foreign) compound and is simply not progesterone, a compound natural to human metabolism.”

Dr. Lee cites research that concludes that “progesterone protects against coronary artery spasm and MPA increases the risk of serious unrelenting coronary artery spasm.” Another well known study using rhesus monkeys demonstrated that progestin (i.e., synthetic, not bioidentical progesterone) dramatically increases spasm in the blood vessels of the heart, while progesterone does not. (See Spasms and the Effects of Magnesium.) Studies also indicate that “MPA correlated with reduced coronary artery flow whereas progesterone correlated with improved coronary artery flow.”

Dr. Lee summarizes his treatment philosophy by stating that “progesterone inhibits the changes that cause cholesterol to become harmful to arteries, and that progestins and estrogens do not have the same effect. In other words, progesterone is uniquely protective of arteries.”

Testosterone

Testosterone also has important cardiovascular benefits, including the ability to lower cholesterol and reduce platelet “stickiness” (as discussed in What About Cholesterol?).

Another benefit of testosterone is that it counteracts the effects of stress. We’ve all heard that stress is a primary contributing factor in heart disease, especially heart attacks, but why is that so? It is because stress raises the concentration of cortisol in our bloodstream, which is known to contribute to atherosclerosis. Testosterone helps protect us against heart disease by balancing the cortisol dominance that results from stress.

In Life Extension, Dr. Edward Rosick discusses a study that hypothesized that “testosterone deficiency is a key predictive factor for heart disease in aging women or women who have had hysterectomies.” The researchers found that “women who have hysterectomies are three times more likely to develop cardiovascular disease compared to women who have not had one.”

Testosterone levels may be improved with bioidentical testosterone supplements. Resistance and endurance exercises are also a natural way for men and women, regardless of age, to boost testosterone levels.

Thyroid

In his book, Solved: The Riddle of Heart Attacks, Dr. Broda O. Barnes reports on his observations of heart disease and the treatment he followed with his patients for more than 50 years. He also summarizes over 100 years worth of data and research on cardiovascular disease, particularly the effects of cholesterol and genesis of atherosclerosis.

Dr. Barnes’ resounding conclusion is that thyroid deficiency is the cause of most heart attacks and that thyroid hormone therapy is the way to improve the health of these patients, regardless of age or sex.

In study after study, patient after patient, Dr. Barnes reports how atherosclerosis is almost always accompanied by thyroid deficiency, whereas high cholesterol levels—even at an early age—do not necessarily result in heart attack or cardiovascular disease. He claims that thyroid therapy, when given early enough in the course of the disease, will prevent cardiovascular disease and improve quality of life and life expectancy.

There is a clear link between thyroid hormones and normal heart function. For example, the majority of hypothyroid (i.e., thyroid deficient) patients exhibit hypertension, even among children with low thyroid function. There is also a relatively high incidence of heart attacks and strokes among patients with thyroid deficiencies, and an extremely high rate of atherosclerosis among patients who had thyroidectomy.

Prevention is the Key

Cardiovascular disease is not the inevitable result of aging, and preventive measures can be taken to avoid it. According to the Prescription for Natural Healing, approximately 50 million Americans are afflicted with heart and blood vessel disease, most without exhibiting any symptoms. The first sign that something is wrong could be a life-threatening calamity, so the time to act is before symptoms arise. It is far easier to prevent cardiovascular disease than it is to cure it.

As Dr. Lee points out, “Health is the condition we enjoy when all systems are in balance.” This statement is particularly true with regard to hormone balance, and the heart is one of the first organs to experience problems when there is an imbalance. Maintaining optimal hormone balance is an integral step in preventing cardiovascular disease and enjoying a healthy heart.