Updated December 18, 2014.
Heart disease is the leading cause of death among women today, yet women's heart problems are frequently overlooked. Many of us are more worried about breast cancer, which is far less likely to strike a woman than a heart attack. Stephen Sinatra, M.D., F.A.C.C., F.A.C.N., is a board-certified cardiologist and certified pyschotherapist with more than 25 years of experience helping patients prevent and reverse heart disease.

In Dr. Sinatra's book, Heart Sense for Women: Your Plan for Natural Prevention and Treatment, published by LifeLine Press, he explores the innovative information about heart disease and women, including early warning symptoms, cholesterol, homocysteine, lipoprotein , and LDL oxidation, plus a natural program for reducing blood pressure and reducing reliance on medication.

I had an opportunity to talk to Dr. Sinatra about Heart Sense for Women, and what he felt that women with thyroid disease should know about thyroid disease.

Is There An Increased Risk of Heart Disease for Thyroid Patients?

According to Dr. Sinatra, writing in the September 2000 edition of his newsletter, "HeartSense," even subclinical hypothyroidism -- having normal to high-normal TSH levels -- can increase risk of heart disease in women. Dr. Sinatra puts that risk at '14 percent, or similar to the risk associated with the combination of high blood pressure and cigarette smoking."

Still, Dr. Sinatra believes that the main risk is not a causal one, where thyroid problems directly cause the heart problems.

Rather, says Sinatra, "if a woman has a thyroid problem, she needs to know that her risk is increased not necessarily because of the thyroid disease or the drugs she's taking specifically, but because of the other risk factors -- weight gain, lipid abnormalities, etc. -- that result from the thyroid disease. A woman with thyroid disease needs to take more responsibility for her heart."

What's the Role of Coenzyme Q10?

One contributing risk factor, according to Dr. Sinatra, is deficiency of Coenzyme Q10, or CoQ10, as it's known. Dr. Sinatra considers CoQ10 a true wonder-nutrient, because, as he says in his book, "it essentially improves the heart's ability to pump more effectively."

Women are naturally more deficient in CoQ10, and nowhere are deficiencies in this nutrient greater than in women with thyroid conditions. "If there is one thing a female thyroid patient can do, it's supplement with CoQ10," Dr. Sinatra says.

In particular, hyperthyroidism is a key risk for women. Says Dr. Sinatra, "If a woman is hyperthyroid, this can be a disaster, because in hyperthyroidism, a hyperactive thyroid gland can burn up all the CoQ10 in the body. The metabolism is so high that CoQ10 is stolen away from the heart. When this happens, the woman can go into heart failure. "Many times I have seen hyperthyroid storm in a woman associated with heart failure. We didn't understand why women got heart failure and hyperthyroidism at the same time. We used to think it was a virus, but now we know the hyperthyroidism takes away the CoQ10."

Dr. Sinatra could not emphasize enough how important he feels CoQ10 is for women with thyroid disease. "The way I treat women with any thyroid problem is with a minimum of 100-200 mg of CoQ10. If a woman is on a statin drug, or has heart problems, then 200-400 mg a day."

Thyroid Drugs: The Controversy Over T3

I asked Dr. Sinatra if he felt that the use of T3 was a danger to the heart, as some doctors claim. With some patients, Dr. Sinatra is particularly cautious. "For a woman with heart disease or active angina, T3 can be a problem. It can make the heart work harder. Under those circumstances I would hold back T3."

Otherwise, Dr. Sinatra prefers the desiccated natural form of thyroid hormone, Armour, which includes both T4 and T3. He did not feel that it poses any special dangers to patients.

"If there is one thing a female thyroid patient can do, it's supplement with CoQ10," -- Dr. Stephen Sinatra

In the October 2000 issue of his newsletter, Dr. Sinatra says, "Be very skeptical of any health care provider who says that there's only one type of thyroid treatment that works. There are generally two opposing 'camps' on this subject, each with their own dogma. One postulates that synthetic thyroid is the only safe and effective medication, while the other endorses only 'natural' thyroid as an effective treatment option. However, both camps are correct in part. Some patients respond only to traditional pharmacologics while others will respond only to Armor, or natural hormone."