METABOLIC SYNDROME

The metabolic syndrome in postmenopausal women

By Benjamin J. Ansell, MD

Although nearly 40% of women have metabolic syndrome and the incidence is rising, the condition remains underdiagnosed. Clinicians who treat postmenopausal women should increase their awareness of the metabolic derangements associated with the syndrome and consider them when weighing hormone therapy options.

Coronary heart disease (CHD) is the number one killer of American women, and yet most women do not perceive themselves to be at risk. The prevention of CHD in women is usually made more difficult by the absence of symptoms prior to a myocardial infarction (MI) and a relatively high risk of sudden death as the initial presentation of the disease.¹ Furthermore, our prevention and treatment strategies have focused on a paradigm reflecting the presentation of coronary disease in men. While men experience slightly greater risk of MI prior to age 65, women surpass men in coronary risk after this age.² Overall now, American women have slightly more heart attacks than men, and a slightly higher fraction of women than men die from heart disease.^2,3 The relative importance of CHD is evident when one considers that heart disease kills 37% more American women than all types of cancers combined, including about 10 times more than die from breast cancer.³

At any age, an American woman is more likely to die from heart disease than from breast cancer. Still, many women do not feel themselves to be at risk for heart attack. A Gallup poll conducted for the National Center for Health Statistics showed that 40% of women perceive breast cancer as their greatest health threat, compared with just 4% who expect to die from heart disease.⁴ The Acquired Immune Deficiency Syndrome (AIDS) presents as great an apparent health concern as CHD, cited by 4% of the respondents. In reality, the cause of death for 30% of women is heart disease, compared with 4% from breast cancer and fewer than 1% from HIV.³