Health cardiology conference

Prasanna Sugathan, a cardiologist with Cardiovascular Associates, talks about heart disease in women during an interview at UnityPoint Health-St. Luke's.

SIOUX CITY | Road races and walks are held around the country each year to bring awareness to breast cancer.

NFL players sport pink gloves, shoes and towels every October in honor of National Breast Cancer Awareness Month.

Prasanna Sugathan, a cardiologist with Cardiovascular Associates, wonders why heart disease, which is the No. 1 killer of women in the United States, doesn't get the same recognition.

While 1 in 31 U.S. women dies from breast cancer each year, 1 in 3 dies of heart disease.

"If you ask any woman about what they're worried about, breast cancer is probably mentioned very quickly," she said. "That tells me that they've done a better job with the teaching about breast cancer and prevention and early recognition of it than we have."

Women's health, hormones and heart disease will be a topic on the agenda at the 32nd annual Cardiology Conference, which will be held Oct. 19 at the Sioux City Convention Center. The conference is sponsored by UnityPoint Health-St. Luke's, Cardiovascular Associates and Mercy Medical Center.

Sugathan said the conference is a good opportunity for both primary care physicians and specialists to learn about the latest procedures and medications available in a field that has changed by "leaps and bounds" over the years.

Patricia Best, a cardiologist at the Mayo Clinic in Rochester, Minnesota, will speak at the conference about new research that examines whether giving hormonal therapy closer to the time of menopause may benefit a woman's cardiovascular health. Women usually develop heart disease about 10 years later than men do.

Best said hormones play a part in that process. Estrogen and normal hormonal milieu help to raise HDL, or "good" cholesterol in the body, while lowering LDL cholesterol, or "bad" cholesterol. During menopause, a woman's body produces less estrogen and the hormone progesterone.

"At the time of menopause the lipid profile gets worse," Best explained. "Basal motor symptoms have also been associated with heart disease -- hot flashes and other things, so that estrogen withdrawal also seems to be part of the increased risk for coronary disease. There's an accelerated process of coronary artery disease at that time period."

Could hormone replacement therapy reduce a woman's risk of heart disease?

Current guidelines don't recommend hormone replacement therapy for the prevention of heart disease.

Older studies, Best said, showed no harm or benefit with estrogen therapy in relation to cardiovascular health. But she cited research published earlier this year that produced positive outcomes for women who started estrogen therapy soon after menopause.

"What they found is those women who were started early in the post-menopausal period did have a reduction in the development of the carotid artery intimal medial thickness progression compared to those given it late in menopause or compared to those who were treated with a placebo," she said.

Sugathan said patients need to focus on what they can do as individuals to prevent heart disease and not depend on medications. Although minimally invasive treatments, such as coronary balloon angioplasty and stenting, are alternatives to major heart surgery for many patients, Sugathan said she thinks of these advancements as "fancy bandages and not cures."

"We need to be aware of our risk factors. I tend to separate the risk factors to ones you can modify, like the smoking cessation, and others that you cannot modify, like the family history," she said.

"If you have a lot of non-modifiable risk factors, then you need to be that much more aggressive with your preventative care plan."

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