Women's Cardiovascular Disease
Significant differences exist in the epidemiology, diagnosis, treatment, and prognosis of
coronary heart disease between men and women. Women have a higher prevalence of cardiovascular disease than do men once they reach the age of 65. Women are also more likely to die of cardiac disease, which appears to be related to their older age at presentation and their accompanying other medical problems.
# 1 Killer of Women in U.S.
Lack of Awareness
Some of the differences in diagnosis, treatment, and outcome may be attributable in part to a lack of awareness, among both the general population and among health care providers, of the serious threat cardiovascular disease poses to women. A survey done by the American Heart Association found that just 21 percent of women were aware that cardiovascular disease is the number one killer of women in the U.S. Physicians were even more unaware of these numbers, the study said.
Low Awareness of Risk
"Another interesting survey done in 2005 of over 1,000 women showed that 36% of these women did not perceive themselves to be at risk for coronary disease, although we know that over 40% of women who die each year die of cardiovascular diseases," says cardiologist
Loryn Feinberg, MD, director of the
Women's Cardiovascular Program at the
Women also may have fewer "typical" symptoms of coronary artery disease than their male counterparts. Men often experience "classic" symptoms of
angina, such as tightness in the chest which radiates to the arm and shortness of breath.
Women may experience pain that is described as more intense, different in quality (such as burning or sharp), more frequently located in the neck/throat or radiating to neck and jaw. Also, excessive fatigue and shortness of breath are frequent symptoms. Symptoms in women may be induced by mental stress in addition to physical exertion.
Tests Less Informative
Some non-invasive tests for diagnosing
heart disease, such as
treadmill tests, are also not as accurate in women as they are in men. The sensitivity and specificity of detecting disease is reduced.
"However, using imaging modalities along with the stress test, such as a nuclear study or an accompanying
echocardiogram, appears to make the test equally sensitive and specific in diagnosing coronary artery disease in both men and women," reports Dr. Feinberg.
When women have an abnormal stress test, they appear to be referred for more invasive testing, such as
cardiac catheterization, less often than their male counterparts.
Mortality Rate Higher for Women
Women More Likely to Die
Women with coronary artery disease are also more likely to die than men. In the United States, while the mortality rate in men has been steadily declining over the past 15-20 years, cardiovascular mortality for women with coronary artery disease has remained flat or increased slightly during the 1980s-1990s. Unfortunately, mortality rates for women have exceeded those for men over the past 20 years.
The reason for this disparity in outcome may in part be due to the fact that, according to a Washington state study, fewer women who suffer
heart attacks are eligible for clot-busting drugs compared to men, for a variety of reasons.
Often, women with chest pain delay going to the emergency room. According to Dr. Feinberg, "Although some studies have suggested decreased use of cardiac catheterization and coronary revascularization with
angioplasty and/or stenting in women with heart attacks, this is not entirely clear. In very large registries of patients (>500,000 men, >300,000 men), women were nearly as likely to undergo PCI (non-surgical, percutaneous coronary interventions such as stenting) for appropriate indications."
Complication Rates May Be Higher
Heart Failure and Shock
However, Dr. Feinberg said, "Women are known to develop
heart failure and shock from their myocardial infarctions (heart attacks) more frequently than men, and have a higher rate of bleeding complications. These factors can certainly negatively impact a woman's outcome."
Good News and Bad News
The good news is that the success rate for medical and procedure-based treatment of coronary heart disease is equally effective in men and women. The bad news is that complication rates appear to be worse in women under certain circumstances. These include a higher rate of short-term complications after cardiac catheterization with accompanying stenting and after
Fortunately, the outcomes and long-term survival after bypass surgery and percutaneous coronary procedures (such as stent placement) for men and women appear to be equal after the first year. Also, much of the increase in risk in women appears to be related to their older age at presentation and their other accompanying medical problems.
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