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Women and Heart Disease: Research & Prevention By Lisa Collier Cool How Women Get Shortchanged Research shows that women with heart disease are less likely than men to receive potentially life-saving treatments. "After a heart attack, they're less likely to be sent to cardiac rehabilitation, or to get medications like beta blockers, ACE inhibitors, or even aspirin to reduce the risk of a second heart attack," says Marianne Legato, MD, professor of clinical medicine at Columbia University College of Physicians & Surgeons and the founder and director of the Partnership for Gender-Specific Medicine at Columbia University, in New York City. Although nearly equal numbers of men and women get heart disease, women receive only 33 percent of angioplasties (insertion of a balloon-tipped catheter to reopen blocked vessels), stents (mesh tubes used to hold clogged vessels open), and bypass surgeries. All this may explain another deadly disparity: 38 percent of women die within a year of their first heart attack, compared with just 25 percent of men. Until recently, doctors didn't know much about women's heart disease or the best treatments because, in the past, most major research studies were conducted on men. Indeed, women comprise only 25 percent of participants in all heart-related studies done to date, reports the National Coalition for Women with Heart Disease. "There's a Catch-22; doctors don't use interventions like angioplasty or bypass surgery as aggressively for women as they do for men, because the effectiveness in women hasn't been studied as extensively," says JoAnn Manson, MD, chief of preventive medicine at Harvard's Brigham and Women's Hospital, in Boston. "As a result, women with heart disease sometimes end up being deprived of treatments that have already been shown to be beneficial in men." However, now that more women are being enrolled in randomized clinical trials -- the gold standard of research -- physicians are finally starting to get answers about what works and what doesn't. Although doctors used to think ACE inhibitors weren't as effective for women, in October 2002, the Heart Outcomes Prevention Evaluation (HOPE) Study of 2,480 women who had heart disease or were at high risk of getting it showed that the medication has the same life-saving effects for women as it does for men. The women who received it were 38 percent less likely to die from cardiovascular disease. Another large 2002 study at Cardiac Centers of Louisiana found that beta blockers increase survival in women just as much as they do in men. Prevention Is Key Of the 435,000 American women who have heart attacks each year, 2 percent are under age 45, and 19 percent are younger than 65. The average age for a first heart attack in women is 70.4, compared with 65.8 for men. (But if you smoke, here's another good reason to quit; women smokers risk having a heart attack 19 years earlier than nonsmokers do.) Yet most women aren't focused on keeping their heart healthy because they're just not aware of their risks. And doctors aren't doing much to warn women of the danger. When the American Heart Association surveyed more than 1,000 women in 2000, 62 percent said their doctor had never discussed heart disease with them. That's alarming, because recent surveys conducted by several hospitals around the country show that about 80 percent of women age 40 and up have at least one risk factor for heart disease -- and more than half have two. (Dr. Goldberg says the percentage is about the same for men.) While the most serious heart hazards are the same for men and women, some affect women more. For example, type 2 diabetes and HDL of less than 40 mg/dL are particularly risky for women, says Dr. Legato. Other risk factors include high blood pressure, high cholesterol, diabetes, smoking, high stress levels, being overweight (especially having fat around the abdomen), leading a sedentary lifestyle (sitting 16 hours or more a day raises risk by 70 percent, according to a study in the New England Journal of Medicine) or having a family history of heart disease (especially a parent who died of it before age 55). New research shows that the immune system's inflammatory response also contributes to clogged arteries. Inflammation may be caused by bacterial or viral infections, smoking, diabetes, high blood pressure, and high cholesterol. Women's risk also doubles or triples after menopause, due to the lack of the protective effects of estrogen. The more of these factors you have, the greater your danger. The real key to saving lives, therefore, regardless of gender, is prevention. "Heart disease is not inevitable," says Dr. Goldberg. "Most risk factors can be reduced, or even eliminated, by lifestyle changes." In fact, Dr. Manson says that more than 80 percent of heart attacks could be prevented by lifestyle factors such as not smoking, being physically active, maintaining a healthy weight, eating a heart-healthy diet, and drinking alcohol in moderation. And the earlier you start taking steps to protect your heart, the safer you'll be, since plaque buildup can begin even when a woman is in her 20s or 30s -- though it usually takes decades before clogging gets bad enough to trigger a heart attack. "There's a lot you can do to protect yourself before your arteries get blocked from years of being overweight, smoking, or eating a high-fat diet," says Dr. Goldberg. "If gynecologists and primary-care doctors talked to every woman about heart disease, more lives would be saved." A good working relationship with your Primary Care Provider is a key to good health. If this series of articles has raised concerns about your heart health, be sure to have a conversation with your PCP. SOURCE: Reprinted with permission from Lisa Collier Cool Ladies Home Journal, February, 2004 http://www.lhj.com/ (June, 2006)