Reference: March 2024 | Issue 3 | Vol 10 | Page 27
Cardiovascular disease (CVD) is a leading cause of death globally and poses a major health and economic challenge. Approximately 9,000 people in Ireland die from CVD every year, despite an estimated 80 per cent of premature deaths being preventable. Ireland has also been identified as having the lowest rates of detection of hypertension in western Europe.

To promote primary prevention and improved cardiovascular outcomes, Consultant Interventional Cardiologist Dr Roisin Colleran, Mater Private Hospital, Dublin, talked to Update about the importance of promoting a healthy diet and lifestyle, recognising and treating heart disease in women in particular, and urging all patients to “take care of their cardiovascular health”.
Dr Colleran’s specialty interests include general and interventional cardiology and her areas of expertise encompass cardiac catheterisation; angioplasty and stenting; quantitative coronary angiography; optical coherence tomography; and coronary physiology.
Her specific areas of interest are high-risk patient and lesions subsets undergoing percutaneous coronary intervention; patients at high bleeding risk; antithrombotic therapies in patients undergoing coronary stenting; drug-eluting stent and balloon technologies; myocardial revascularisation failure; and structural intervention. Despite her extensive education and skills, “keeping patients away” from her office is Dr Colleran’s primary aim.
Urging patients to ‘know their numbers’
Speaking to Update, Dr Colleran described the importance of urging patients to take responsibility for, and play an active role in, their own heart health – from recognising concerning signs and symptoms, to monitoring their own progress and modifying risk factors. “It’s important they [patients] get any symptoms checked out,” she said, and added that even patients who do not have typical cardiac symptoms or existing CVD should still be encouraged to “know their numbers” in terms of blood pressure, cholesterol, blood glucose, and other clinical markers.
“For patients that have a risk factor in adulthood, whether it be dyslipidaemia or blood pressure, it’s important they know that even if they get that risk factor back to target with medication, they are still at higher risk than somebody that doesn’t have that risk factor. None of these things have symptoms, so it’s really important to start checking for them from a certain age. At what age is debateable….
“The American Heart Association would recommend that everyone from the age of 20 should have blood pressure, cholesterol, and fasting sugar checked at least once. If it’s fine, you don’t have to repeat this for another five years or so, but at least if it’s borderline, then it’s highlighted and we can keep an eye on it.”
A ‘higher index of suspicion’ in female patients
Dr Colleran acknowledged the benefits of educating all patients to recognise early warning signs of CVD, and advocated an improved focus on female heart health, despite women generally having a slightly lower prevalence of CVD than men. “Women are, on average, protected for about 10 years longer than men because they go through the menopause between 45 and 55 normally,” Dr Colleran said.
“However, CVD is the number one killer in women as well as men,” she added, before highlighting the cardiovascular risks associated with normal menopause and extended risks in early menopause. She also told Update that clinicians should have “a higher index of suspicion” when treating women, particularly in view of the fact that they often present with atypical early and/or late warning signs.
“The biggest early warning sign would be angina – chest pain on exertion. In women or men that is the most common presentation of heart disease. We know that women more often than men can have strange or atypical symptoms though. They may have pain in atypical locations like the shoulder, abdomen, or back, or may present with other symptoms like dizziness or palpitations when it is coronary artery disease or a heart attack.”
Referring to a previous case, Dr Colleran described a female patient who presented with no major symptoms other than a fluttering sensation in her shoulder, had normal cardiac and routine blood results, and an unremarkable electrocardiogram. “This lady actually had a coronary artery dissection,” she said, and added that physicians should also consider the fact that female patients generally tend to present later than male patients, be diagnosed later than males, and are “under-studied and under-represented in clinical trials” in cardiology.
Dr Colleran went on to highlight that like symptoms, the causes of chest pain in women can also be less common and typical than in men. “Men will most often have a blockage of an artery, whereas women might have something more unusual like a coronary artery dissection or a Takotsubo myopathy, which is often associated with emotion or grief,” she added. “Women also tend to be treated at a lower rate with guideline-directed therapy, such as lower doses of statins after a heart attack.”
Lifestyle and primary prevention
Primary prevention is a central aspect of cardiology care, Dr Colleran told Update. “As an interventional cardiologist, I see a lot of coronary disease when it’s reached the obstructive stage, or at least when there’s deposition in the arteries, rather than at the preventive stage,” she said, before discussing the importance of preventative education and interventions.
“Medications have their role, but it’s better to intervene at an early stage.”
“It really begins in childhood,” Dr Colleran said about prevention, and went on to talk about how technology in particular has replaced active playing and exercise for many children and young people. “Children are in general much more overweight,” she noted, and described the ongoing obesity challenges and negative dietary patterns often seen in Ireland and western Europe.
“These are all the risk factors that will eventually lead to CVD. If we can prevent children from developing these risk factors by not having them on processed diets, encouraging low sugar, low salt, and low fat for prevention of obesity, diabetes, and dyslipidaemia going forward…. Simple measures can go a long way in preventing morbidity and mortality down the line.”
Summarising her message to fellow physicians and clinicians, Dr Colleran concluded by saying: “It’s really about checking the risk factors, trying to prevent them developing, and making sure we treat to target if patients do have them…. Finally, don’t overlook and take women’s symptoms seriously.”
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