Download Women and Heart Disease—Research and Prevention

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)