Women Missing Out on Heart Disease Diagnoses, Treatments
HealthDayNews — Women often miss out on lifesaving diagnoses and treatments for heart disease, even though it kills them more often than any other illness.
That’s the unequivocal message of several studies appearing in a themed issue of the journal Circulation, which is being released at a news conference Tuesday to coincide with the beginning of American Heart Month. Friday is National Wear Red Day, when the National Institutes of Health, the American Heart Association and others ask Americans to wear something red to show support for the fight against women’s heart disease.
Some of the more troubling findings from the studies include the fact that only a third of women who have a high risk of heart disease are actually getting statins or other cholesterol-lowering medications, and many women who would benefit from cardiac imaging tests that screen for heart disease are simply not getting them.
"Since 1984, more women than men die each year from heart disease," said Dr. Robert Eckel, president-elect of the American Heart Association. "It’s not the time for complacency."
"We continue to see that women’s cardiovascular risk factors are not adequately cared for," said Dr. Nieca Goldberg, chief of women’s cardiac care at Lenox Hill Hospital in New York City and author of Women Are Not Small Men.
Cardiovascular disease, including stroke, remains the leading cause of death among women, claiming 500,000 lives each year. Despite the numbers, many people, including and perhaps especially physicians, seem to be unaware of this reality.
"This should be old news," added Dr. Stephen Siegel, a clinical assistant professor of medicine at New York University School of Medicine. "The whole concept of women having heart disease was relatively new 15 or 20 years ago. It’s been in the literature, in the lay press, on television, in newspapers for at least 10 years, and the fact that there are still physicians who seem to treat women differently than men is a little bit surprising and disturbing."
But that’s exactly what one of the studies found: Women are less likely than men to get preventive recommendations from their doctors, and this gap is because physicians of all kinds tend to perceive heart disease risk as lower in women.
The researchers conducted a national online survey of 100 cardiologists, 100 obstetricians/gynecologists and 300 primary-care physicians. Each doctor was given profiles of patients with the same risk level but different genders, and asked to make recommendations. Despite the equivalent risk profiles, women were much more likely to be classified as lower risk.
Also, fewer than one in five physicians knew that more women than men die of heart disease each year. Doctors, especially gynecologists, did not give themselves very high marks for being effective in helping patients prevent cardiovascular disease and manage risk factors. Gynecologists were much less aware of national guidelines for cholesterol and blood pressure than primary-care physicians. At the same time, gynecologists reported that they provided primary care to two-thirds of their patients, indicating they have an important role to play in the battle against heart disease.
"We were excited to learn that we could explain the differences in treatment patterns based on what the doctor’s perception of a patient’s risk was. And we could nearly explain all of our findings by the fact that women were more likely to be assigned to be at lower risk despite the fact that, in our experimental design, we precalculated the risk group to be identical," said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital and associate professor of medicine at Columbia University in New York City. "This suggests that if a physician puts a woman in [an] appropriate risk category, then she will receive equal treatment."
"As we increase awareness in women of their risks of heart disease and empower them, their expectations are increased of what they’re going to get at the doctor’s office," Goldberg said. "We really need to spread education out to primary-care physicians, internists, gynecologists."
Another study found that almost two-thirds of women with dangerously high cholesterol levels were not getting the medications they needed. This group of women was at the highest risk for heart attacks and strokes.
After analyzing 1.1 million members of a managed-care organization, the study authors found that only about one-third of these women were receiving statins or other cholesterol-lowering medications. Even fewer women received niacin to boost HDL (good) cholesterol levels or fibrate therapy to lower triglyceride levels, the study reported.
Finally, this issue of the journal included a consensus statement from the American Heart Association stating that cardiac imaging methods such as stress single photon emission computed tomography (SPECT) and stress echocardiography work equally well in women as in men to diagnose coronary artery disease. But women who are at risk for it aren’t referred for the right tests as often as their male counterparts are.
However, the common exercise treadmill test does not work equally well for all women, said Dr. Jennifer Mieres of North Shore University Hospital in Manhasset, N.Y.
More information
New York University School of Medicine
The American Heart Association has more on women and heart disease.
SOURCES: Stephen Siegel, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; Nieca Goldberg, M.D., chief, women’s cardiac care, Lenox Hill Hospital, New York City, and author, Women Are Not Small Men; Feb. 1, 2005, news conference with Robert Eckel, M.D., president-elect, American Heart Association, and Lori Mosca, M.D., Ph.D., director, preventive cardiology, New York-Presbyterian Hospital, and associate professor, medicine, Columbia University, New York City; and Jennifer H. Mieres, M.D., North Shore University Hospital, Manhasset, New York University; Feb. 1, 2005, Circulation~DOCS~~STRO~~CORA~~BLPR~~WMEN~