Women and Heart Disease

Women get inferior care for heart disease. It has long been accepted that women suffer higher risk of undertreatment when they present with chest pain in the emergency room, and a recent analysis of a global database of patients with heart attack, also known as acute coronary syndrome, confirmed earlier studies that showed women are undertreated for this disorder. The investigators found that women were less likely to receive an angiogram, statins, ace inhibitors, aspirin or beta blockers when compared to men. Some reasons for the differences may be that women do not always present with the typical symptoms of crushing substernal chest pain. Women may develop neck or jaw pain or burning epigastric pain.

When women do have an angiogram they tend to have milder disease. This difference in severity of disease does not reduce the risk of future heart attack or death. Even if the arteries are only 60 to 70 percent blocked this may be a site of future heart attack. The genesis of heart attack is the moderately narrowed artery that has a rich layer of cholesterol and inflammatory contents that when exposed to the blood causes a clot to form, which can lead to complete cessation of flow. Women are generally protected by estrogens, but after menopause begin to assume the risk profile of their male counterparts. Most people don't recognize that more women die from cardiovascular causes than breast and ovarian cancer combined.

In an effort to increase the awareness that women are affected by heart disease, the American Heart Association developed the Red Dress Campaign. Its major goal is to reduce the mortality of women presenting with acute coronary syndrome and heart attack. The first step is to make women aware that they are every bit as susceptible to the disease as men. Unprovoked chest discomfort should not go without a doctor's evaluation, which often includes a treadmill stress test, stress echocardiogram or stress thallium test. If these preliminary tests are abnormal, aggressive treatment of risk factors with aspirin, beta blockers, statins and ace inhibitors is indicated. If symptoms persist despite medical treatment, an angiogram is in order.

Treatment with hormones is controversial; currently treatment with estrogens and progestins is not indicated to reduce the risk of heart attack in women. Data from the Women's Health Initiative trial demonstrated an increase in the risk of heart attack in the first several years of therapy in post menopausal women. Currently patients using hormones for symptoms who have been on them for years should not stop because of heart concerns. The risk of heart attack seems to be highest after the initiation of treatment.

Women who have risk factors of smoking, diabetes, high blood pressure, cholesterol and family history of heart attack should be keenly aware of the signs and symptoms of heart attack and be cognizant of the fact that an atypical symptom should not be ignored. In order to reduce your chance of progressive vascular problems, see your doctor and take control of these risk factors with their guidance.