| U-M study reveals major differences between women and men in cardiovascular disease
Women show different patterns of heart disease, which leads to less aggressive treatment of symptoms, U-M researchers find
A new study shows just how different men and women really are – when it comes to their hearts, that is. It also helps solve several mysteries about women and heart problems, and highlights the need for better treatment of the No. 1 killer of women.
The study, led by researchers from the University of Michigan Cardiovascular Center, shows that women who suffer chest pain or a heart attack are more likely than men with the same conditions to have only mild spread-out blockages in their major arteries.
When men and women with similar rates of heart attacks were compared, the women were less likely to get aggressive drug treatment, according to research presented at the American Heart Association's Scientific Sessions 2003.
Since women’s large blood vessels were more likely to be clear when examined via angiography, the authors think they may have found the reason why so many women leave the hospital without a firm diagnosis and with a less aggressive therapy regimen after experiencing acute heart symptoms.
That finding may explain why men are more likely than women to have angioplasty or bypass surgery, which are most often done only after severe blockages or narrowings are spotted on an angiogram.
Researchers were especially surprised by the disparity in drug therapy, including the use of aspirin, beta-blockers and clotbusters in the hospital, and aspirin and beta-blockers at discharge. Such drugs are recommended for nearly all people who suffer heart attacks.
"The question of whether there is some sort of bias against women in heart treatment has been around for some time, and in fact our data do show a bias against giving women more aggressive therapy," says Sujoya Dey, M.D., the U-M cardiology fellow who led the analysis. "But, our findings also suggest the bias may be understandable, because women’s coronary artery disease on average appears to be different. It’s more likely to be diffuse, occurring in vessels too small for angiography, angioplasty or bypass."
Explains Kim Eagle, M.D., the senior author on the study and clinical director of the U-M Cardiovascular Center, "This actually may help debunk the theory that women are being offered less treatment because of bias based solely on their gender. The bias may stem from the nature of their disease."
Coronary heart disease, which includes heart attack and angina, is the single leading cause of death among American women, killing 254,630 in the year 2000, according to AHA. About 210,000 women will have a heart attack this year, and angina affects 4.1 million women (compared with 2.5 million men).
In all, 6.6 million American women alive today have a history of heart attack, angina or both.
The bottom line, says Dey, is that there’s a difference in disease and treatment that both doctors and patients need to pay attention to. "Women may on the whole have more mild-looking disease than men, but even when they had similar-looking disease they were still under-treated," she says. "If your angiogram looks the same you should be getting the same medical therapy."
Over all, Eagle emphasizes, the findings mean that physicians should be more aggressive with prescribing medications to women with signs of heart disease, because those drugs can help keep blood vessels clear, prevent clots, and keep vessels from hardening.
And women should speak up for themselves, adds Dey. "Believe yourself and your symptoms, and bring them to the attention of your physician to figure out how to help you," she says. "Don’t be afraid to ask what else they could be doing for you."
Written by Kara Gavin |
