A message from the heart: Cardiac care vital for women, too

Women face an underappreciated risk of cardiovascular disease.

Editorial. May 26, 2003.

This month brought another Mother's Day, a time to celebrate the women who play a central role in our lives. Now that the flowers have been delivered and the brunches eaten, a much-needed and enduring way to honor these and all women requires attention. It is to create, and act on, greater awareness of cardiovascular disease among women.

In our society, heart disease is thought of as a male problem. But it's actually indiscriminate, ranking as the No. 1 killer of both American men and women. For women, this tally translates into one in three stricken, and more than 500,000 lives lost annually. Women tend to be most aware of cancer risks, but heart attack, stroke and related diseases are responsible for almost twice as many female deaths than all forms of cancer combined.

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Yet only about one-third of women are aware of these sobering statistics, according to the National Heart, Lung and Blood Institute. Women also fail to link chronic conditions, such as high blood pressure and high cholesterol, with their chances of developing cardiovascular disease.

Meanwhile, the same misperceptions that lead women to dismiss cardiac symptoms sometimes distract physicians from addressing them. Heart disease in women often goes untreated until a crisis point. Diagnosing heart attack in women is a challenge because they are not likely to experience the classic symptoms. Women present with mid-back pain, nausea and or vomiting, and palpitations instead of intense chest pains. And evidence suggests that because of these and other factors, doctors tend to treat female patients differently -- recommending preventive interventions less frequently, ordering fewer diagnostic tests and taking less aggressive steps in emergencies.

Part of the problem, of course, is that only now is medical research beginning to focus on the gender differences in disease and health outcomes. That's why the AMA favors increased women's health research and participation of women in clinical trials. The results will lead to the development of evidence-based, gender-appropriate prevention and treatment strategies. And the Association's Council on Scientific Affairs notes that cardiovascular disease is an area in which significant differences and prevention opportunities exist.

Consider the following: Most women who have heart attacks experience their first one after age 70 -- about 10 years later than men. This is attributed to the protective effect of certain hormones prior to menopause.

But women have a higher mortality rate, even when statistical data are controlled for age. Similarly, women are more likely than men to die of stroke. And factors such as tobacco use and diabetes seem to damage women's bodies differently.

These findings make addressing the knowledge gap a clear and present challenge. Earlier this year, the NHLBI launched its "Heart Truth" campaign, aimed at women ages 40 to 60, at the time in their lives when risks are on the upswing. Its message: "Talk to your doctor, find out your risk and take action today to lower it."

It's a message physicians also must be more receptive to. According to the American Heart Assn., women report that doctors do not often mention heart disease when discussing general health.

This despite the fact that physicians have regular interaction with this population -- women account for 59% of all office visits -- placing them well within reach of preventive medicine. The bottom line, then, according to a CSA report, is that increased attention by physicians and female patients to modifiable risk factors for cardiovascular disease is crucial, given the toll this disease takes on women's health and longevity.

So, don't stint on the flowers and brunch, but be just as generous in promoting good cardiac health.

ADDITIONAL INFORMATION:

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AMA Council on Scientific Affairs report on women's health, "Sex- and gender-based differences in health and disease" (www.ama-assn.org/ama/no-index/about-ama/13607.shtml)

National Heart, Lung and Blood Institute, The Heart Truth, national awareness campaign for women about heart disease (www.nhlbi.nih.gov/health/hearttruth)

American Heart Assn. (www.americanheart.org)