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When you think about cardiovascular diseases, the thought immediately turns to the protection that estrogen hormones offer to the woman. It is always thought that the man is at risk and the woman is not, given that there is this sort of hormonal “umbrella” designed to protect from all the elements that can occur to the arteries. Unfortunately, hormonal protection tends to decline over time and, with the end of fertile life, the female cardiovascular risk progressively approaches that of men. For this reason, risk factors such as excess cholesterol must be kept under control. And we must never forget the therapies indicated by the doctor if necessary. With therapeutic “holidays”, in fact, we put our health at risk. How to behave then? And what can be the tools to increase adherence to care, which is fundamental in heart attack prevention and beyond? Here are the tips of Livia Pisciotta, Associate Professor of Dietary Sciences at the University of Genoa, expert in Lipidology, and referent of the Family Dyslipidemia Center of the San Martino Polyclinic.
How much does cholesterol “weigh” on women’s health?
“The Italian data collected by the Istituto Superiore di Sanità in the period 2008-2012 show that about one in three people has one cholesterolemia total above 240 mg / dl (milligrams per deciliter), more precisely 34.5% of men and 36.5% of women ”explains the expert. If we consider values of cholesterol total above 200 mg / dl, this situation is found in more than half of the people, ie in 65% of men and 67% of women. Cholesterolemia in women it tends to rise in the period of menopause: the average value of total cholesterol increased in the decade 2002-2012 passing from 219 to 226 mg / dl, and this reflected on the prevalence of hypercholesterolemia, which rose from 36% to 51% “. In short: menopause becomes a sort of “watershed” for the fair sex, which should not be underestimated. “That’s right” resumes Pisciotta. “A hypercholesterolemic woman, with the same cholesterol levels, during the childbearing age has a lower risk than a man of undergoing a cardiovascular event. However, it has been observed that cardiovascular events in women, although numerically fewer, are clinically more severe. The often atypical clinical presentation plays a role in this, leading women to neglect symptoms and arrive late for treatment. From menopause onwards, the cardiovascular risk in women increases significantly until it exceeds the risk of males after 10-15 years “. Also for this reason, keeping cholesterol under control must become a fundamental goal in the path of women’s health.
Therapeutic adherence, a possible goal if the diet is not enough
Fortunately, there is some good news. The state of control of hypercholesterolemia in women has recently improved: adequately treated women have increased from 15.3% to 30.2% of the total number of hypercholesterolemics. “But on this front adherence to treatment plays a primary role in reducing risk as the intervention studies highlight significant long-term benefits and epidemiological data show that whoever interrupts treatment loses the benefit of the therapy ”continues Pisciotta. “Women tend to be less adherent than men to lipid-lowering treatments, the reasons are not clear and there are many: however it is hypothesized that women are more inclined to underestimate their level of risk, to think of controlling their risk with diet alone and that they are more attentive to the relational aspects with their doctor of which they are sometimes dissatisfied, not finding adequate answers to their fears related to therapies. Depression is another factor that can affect adherence. Another factor that plays a role in adherence is the presence of multiple risk factors that may necessitate one polypharmacy. In this sense, combination therapies significantly contribute to increasing adherence rates because they reduce the number of daily intakes and are generally more effective, allowing maximum results with minimum effort. This can also have a good psychological impact ”. Final recommendations: if you have high cholesterol, fearlessly pursue a path of lipid-lowering therapy relying on your doctor who today has safe and effective therapies without particular limitations of use. “The doctor, on the basis of the global risk, establishes the therapeutic objectives and personalizes the treatment, even in the event of any intolerances” concludes Pisciotta. “Most women can fully benefit from the first level of care and, if necessary, there are also second and third level therapies, some that can only be prescribed by specialists and reserved for very high-risk cases, which allow them to achieve the objectives of cholesterolemia such as to guarantee real cardiovascular protection. Always remembering that a correct lifestyle is always recommended for everyone but does not always allow to reach the goals of cholesterolemia risk-adjusted “.
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