June 2017 Health Bulletin

Key points from two presentations at the 6th Scientific Meeting of the Asia Pacific Menopause Federation, Singapore 2017

Heart disease and the older woman – Associate Professor Carolyn Lam

  1. Heart disease is the leading killer of women, not breast cancer, in developed countries.
  2. Risk factors include smoking, type 2 diabetes, obesity, mental stress and lack of exercise.
  3. Women often present with less classic symptoms of a heart attack (such as fatigue, hot flushes, back/neck pain, and shortness of breath) than men.
  4. Psychosocial factors, such as depression and marital stress, are a risk for heart disease.
  5. Anxiety may “mask” symptoms of heart disease and lead to delay in treatment.
  6. Acute stress is associated with Takotsubo cardiomyopathy in women, and presents with severe chest pain and can mimic a heart attack. It is reversible and causes no long term damage.
  7. Loss of oestrogen over the menopause compounds heart disease risk with changes in body shape leading to central weight gain, changes in insulin resistance and lipids, increased blood pressure and increased vascular inflammation.
  8. In women, chest pain does not correlate with the severity of coronary artery stenosis.
  9. Conventional screening for coronary artery obstruction does not show the microvascular disease often seen in women.
  10. Women with myocardial infarction have worse outcomes than men despite less severe obstructions in their coronary blood vessels.

Women with increased cardiovascular risk should be working with their general practitioners to reduce modifiable risk factors including stress.

  1. Mallik S, et al. Depressive symptoms after acute myocardial infarction: evidence for highest rates in younger women. Arch Intern Med, 2006. 166(8): 876-83.
  2. Orth-Gomer K, et al. Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. Jama, 2000. 284(23): 3008-14.
  3. Paine NJ, et al. Do Women With Anxiety or Depression Have Higher Rates of Myocardial Ischemia During Exercise Testing Than Men? Circ Cardiovasc Qual Outcomes, 2016. 9(2 Suppl 1): S53-61.
  4. Wittstein IS, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med, 2005. 352(6): 539-48.
  5. Reid IR. Short-term and long-term effects of osteoporosis therapies. Nat Rev Endocrinol, 2015. 11(7): 418-28.
  6. Wallace RB, et al. Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr, 2011. 94(1): 270-7.
  7. Reid IR, Bristow SM and Bolland MJ. Calcium supplements: benefits and risks. J Intern Med, 2015. 278(4): 354-68.
  8. Rautiainen S, et al. Effect of Baseline Nutritional Status on Long-term Multivitamin Use and Cardiovascular Disease Risk: A Secondary Analysis of the Physicians' Health Study II Randomized Clinical Trial. JAMA Cardiol, 2017.

Should women take calcium and vitamin D supplements? – Professor Rod Baber

Calcium and Vitamin D at physiological levels are essential for overall health and wellbeing including bone health.

Calcium
Total calcium intake above the recommended daily allowance does not appear to help bone health [5].Calcium rich foods reduce the mortality due to cardiovascular disease, reduce the risk of atherosclerosis, heart attack and stroke, and reduce blood pressure and blood glucose. The risks of calcium supplementation include gastroenterological symptoms such as constipation and flatulence, an increase in kidney stones and an increased incidence of heart attack.
Thus, adequate dietary calcium is important for health but calcium rich foods should be the priority and supplementation reserved for those unable to achieve the recommended daily allowance.

Vitamin D
Vitamin D is obtained from sunlight, fish and supplements but mild deficiency is common. Severe deficiency has been linked to muscle weakness, risk of falls, and increase in risk of bowel, breast and prostate cancer, osteomalacia and in some studies increased cardiovascular disease. Vitamin D prevents rickets in the young skeleton and may prevent osteoporosis in the older skeleton, however the dose is unknown. It also has a positive effect on psoriasis through antiproliferative effects and may have an effect on cancer progression. However a randomized control trial of over 2,000 women using calcium and vitamin D did not result in a significantly lowered risk of all types of cancer.

Supplementation in high doses, beyond normal values for bone health, is not recommended as this dosing has not been proven to be effective or safe.

  1. Reid IR. Short-term and long-term effects of osteoporosis therapies. Nat Rev Endocrinol, 2015. 11(7): 418-28.
  2. Wallace RB, et al. Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr, 2011. 94(1): 270-7.
  3. Reid IR, Bristow SM and Bolland MJ. Calcium supplements: benefits and risks. J Intern Med, 2015. 278(4): 354-68.
  4. Rautiainen S, et al. Effect of Baseline Nutritional Status on Long-term Multivitamin Use and Cardiovascular Disease Risk: A Secondary Analysis of the Physicians' Health Study II Randomized Clinical Trial. JAMA Cardiol, 2017.



Information provided might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.