Heart Disease: Improving the Female Experience

Heart Disease: Improving the Female Experience

By Andrea Bartels CNP NNCP RNT
Registered Nutritional Therapist

04 Feb 2021

Heart Disease: Improving the Female Experience

If it sounds scary, it should. But don't despair. After exploring women's unique risks, I'll explain important nutritional supplementation for maintenance of cardiovascular health.

Why Women Need to Pay Attention

There are several reasons women and men experience heart disease, diagnosis and treatment differently. Consider that women's anatomy and physiology can make diagnosis more challenging. For example, they experience the symptoms of heart attack uniquely because of differences in heart size and artery width. With smaller hearts, females responding to stress with an increased pulse rate and less blood pumped than a man's (larger) heart. Stressed women also don't necessarily experience vasoconstriction of the arteries like men do, the latter who can then be diagnosed with increased blood pressure. For these reasons, stress tests have proven to be less useful for women than men.

Similarly, the angiogram--which is used to diagnose coronary artery disease (CAD) of the heart-- cannot properly 'see' inside the small arteries, where women tend to experience coronary artery disease; meanwhile, men benefit most from the procedure because their blockages tend to occur in the larger arteries.

Misdiagnosis is Common

Coronary artery disease (CAD) is sometimes misdiagnosed in women and treated as if the problem was digestive, hormonal psychological, or respiratory instead of cardiovascular in nature. This is because symptoms can masquerade as other pathologies, given that they can range from chest pains, heart palpitations, nausea, shortness of breath, to light-headedness. This may be part of the reason fewer women are prescribed blood thinning drugs, cholesterol-lowering drugs and blood pressure drugs that are given to men after their first heart attack. As remarkably unfair as it seems, this is based on data from multiple studies that collectively looked at over 2 million American patients!

Hormonal Risk Factors Through the Life Cycle

The following hormone-related risk factors for heart disease are unique to females:

The condition endometriosis, in which the tissue normally only found inside the uterus is found growing and bleeding in other sites within the abdominal cavity, may be a risk factor for CAD. The Nurses' Health Study II collected data on women and cardiovascular disease for 20 years. Researchers found that of 116,000 females aged 25-42 who had no previous history of heart disease or stroke incidence, those with a confirmed diagnosis of endometriosis had a 52% higher risk for heart attack, a 91% greater risk of chest pain, and 35% risk of undergoing heart surgery compared to women without endometriosis. Researchers are now trying to determine if the higher levels of systemic inflammation, cholesterol and oxidative stress experienced by endometriosis patients may be responsible for the study's findings.

Women with Polycystic Ovarian Syndrome (PCOS), known to impact fertility, are another cohort with higher CVD risk. These women have more risk factors as this disease carries with it a very high risk of obesity and diabetes-which are CVD risk factors themselves.

Pregnancy also brings with it potential risk factors. Pre-eclampsia-characterized by hypertension during pregnancy-may also increase coronary artery disease (CAD), the leading cause of myocardial infarction (known more commonly as 'heart attack'.) Gestational diabetes, while temporary, is also relatively common and can increase the risk of both mom and infant developing diabetes at some point in their lives, raising the risk of heart disease.

In addition, menopause brings a permanent and significant decline in estrogen production. This affects body fat distribution, increasing visceral fat (around the abdominal and chest organs), which is a risk factor for CVD. Plus, losing the protective, vasodilating benefits of estrogen means that smaller arteries may get blocked faster---accounting for the higher incidence of cardiovascular disease in post- menopausal women. Add to this the continued prescribing of hormone replacement therapy (HRT)-- in which unopposed estrogen is used to offset some of the discomforts of menopause. According to the Women's Health Initiative, which was the largest women's health prevention study ever conducted in 2002, found that conventional combination HRT had an increased risk for CVD risk and breast cancer, among other diseases.

So, it should become obvious that women have many extra reasons to worry about developing cardiovascular disease. Aside from the commonly known sensible diet and exercise guidelines, is there anything else that can be done?

The Role of Nutritional Supplementation in CVD Prevention

There is plenty of research that has demonstrated that specific nutrients, when supplemented, provide benefits to the cardiovascular system. Just look at some of the world's most famous peer-reviewed medical journals such as Circulation, Heart, Journal of the American College of Cardiology, European Heart Journal, and Nature Reviews Cardiology and you will find a plethora of studies using supplementary nutrients in the interest of cardiac function. Here, I'll summarize some of the most interesting findings relevant to women and men alike.

Perhaps the most significant and exciting nutrient that supports cardiovascular health is vitamin K2. While other forms of vitamin K-2 are available in supplement form, such as MK-4, research shows that MK-7 is the most bioavailable form. It's the MK-7 form of the vitamin that has demonstrated a significant reduction in arterial stiffness and reduced progression of the calcification that takes place during atherogenesis (the process that creates the build-up of arterial plaques). Specifically, a double- blind, randomized clinical trial in which 244 healthy postmenopausal female subjects took either 180 micrograms of MK-7 or placebo for 3 years---the longest study of its kind-- demonstrated a reduction in arterial stiffness in these women. How does MK-7 work? It appears to activate matrix GLA-protein (MGP)---a protein present in blood vessel walls, which then prevents calcium from depositing in the vessels, where it doesn't belong.

There is NO drug that can do what vitamin K2 does for us, making K2 MK-7 an obvious choice. But not all K2s are created equal. PLV Vitamin K-2 consists exclusively of micro-encapsulated MK-7-the most efficiently absorbed, stable form of vitamin K-2. It is double micro-encapsulated using a unique process that ensures compatibility with supplementary doses of minerals and a long shelf-life. This MK-7 product is dry form, soy-free, and produced from rose and geranium oils.

Other nutrients that can make a positive difference to cardiovascular health include:

Magnesium relaxes the blood vessels, lowering blood pressure-important because hypertension is both a risk factor for, and a complication of CAD. Low magnesium status is also associated with diabetes and Metabolic Syndrome (high cholesterol, hypertension and hyperglycemia concurrently), which are risk factors for CAD. Plus, consuming insufficient magnesium can exacerbate irregular heart beat (arrhythmia), heart muscle diseases (cardiomyopathies) and heart attack (myocardial infarction).

Coenzyme Q10 is a valuable antioxidant, protecting lipid membranes from oxidation---the latter which is a key factor in the atherosclerotic process. CoQ10 is a co-factor in the generation of cellular ATP, or energy, used in great quantity by the heart muscle. The randomized, controlled multicenter trial Q- SYMBIO concluded that long term treatment of patients with chronic heart failure was a safe, effective adjunct treatment that improved symptoms and reduced major adverse cardiovascular events. It's important to realize that while the nutrient can be produced by the human body, ironically, statin drug use for cholesterol control interferes with its production, necessitating supplementation.

Taurine is an amino acid found in the highest concentration in the heart. It too possesses antioxidant benefits, but also has demonstrated anti-inflammatory effects in cases of acute coronary artery disease, producing anti-atherosclerotic activity in animal models. Additionally, taurine helps maintain magnesium and potassium with the heart's cells--critical for electrical stability, strength and regularity of the heart's contractions used to pump blood.

Synergy is everything, and nutrients need teammates to work effectively. PLV Magnesium Glycinate+Taurine+CoQ10 is a formula that combines these three synergistic nutrients that support cardiovascular function. Taking four capsules daily is considered a safe and side-effect-free way to protect the heart.

Better Representation is Happening Now

Thankfully, the research tide is turning, with more and more studies shifting to even out the gender disparities in cardiovascular research. Utilizing nutritional supplementation to support heart health should not be a missed opportunity, especially given the sobering statistics that have shown higher rates of deadly, acute coronary events in Canadian women. Cardiac patients can take action now by talking to their doctor or pharmacist about this exciting research. But don't wait until you're a cardiac patient---or a statistic-to do something proactive for your health. Whether you're female or male, the benefits of nutrient supplementation here are clear.

References/Further reading

  1. Cleveland Clinic. Women or Men-Who Has a Higher Risk of Heart Attack? February 21, 2020.
  2. DiNicolantonio JJ, Liu J, O'Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open Heart. 2018;5(2):e000775. Published 2018 Jul 1.
  3. Harvard Health Publishing, Harvard Medical School. Endometriosis linked to increased risk of heart disease. June 2016.
  4. Harvard Health Publishing, Harvard Medical School. Gender differences in cardiovascular disease: Women are less likely to be prescribed certain heart medications. July 16 2020.
  5. Heart and "Women and Heart Disease". Accessed February 2, 2021.
  6. Knapen MH, Braam LA, Drummen NE, Bekers O, Hoeks AP, Vermeer C. Menaquinone-7 supplementation improves arterial stiffness in healthy postmenopausal women. A double-blind randomised clinical trial. Thromb Haemost. 2015 May;113(5):1135-44.
  7. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010;18(12):598-602.
  8. Melloni C, et al. Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):135-42.
  9. McCarty MF. A taurine-supplemented vegan diet may blunt the contribution of neutrophil activation to acute coronary events. Med Hypotheses. 2004;63(3):419-25.
  10. Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP; Q-SYMBIO Study Investigators. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014 Dec;2(6):641-9.
  11. Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation. 2011;124(19):2145-2154.
  12. Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA. Endometriosis and Risk of Coronary Heart Disease. Circ Cardiovasc Qual Outcomes. 2016;9(3):257-264.
  13. Office of Women's Health, U.S. Department of Health and Human Services. "Largest Women's Health Prevention Study Ever-Women's Health Initiative." Accessed Feb. 2, 2021.
  14. UT Southwestern Medical Center. Do you have endometriosis? Why your heart may be at risk. October 31, 2016
  15. van Ballegooijen AJ, Beulens JW. The Role of Vitamin K Status in Cardiovascular Health: Evidence from Observational and Clinical Studies. Curr Nutr Rep. 2017;6(3):197-205.

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