Digging Deeper

An alarming number of women still don't realize that heart disease is the number one killer of women. In fact, heart disease kills more women than the next sixteen causes of death combined.

In 2006, the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, issued a comprehensive report on cardiovascular disease (CVD) in women. The report included information gathered from numerous AHRQ-funded studies — information that was very surprising, if not very alarming.

These findings highlight the need for women to take charge of their cardiac health and take advantage of the specialized women's heart care provided at Columbia St. Mary's.

The AHRQ report found that one in two women will die of heart disease or stroke, compared to one in 25 women who will die of breast cancer. Research also found that women may not be diagnosed or treated for CVD as aggressively as men, and that women's symptoms during a heart attack may be very different from men's. In addition, statistics indicated significant differences between men and women in survival following a heart attack. Forty-two percent of women who have heart attacks die within one year compared with 24 percent of men.

Following are more specific findings from the AHRQ report:

Management of Chest Pain Differs by Sex.

For the AHRQ report, researchers analyzed the care of 72,508 people with hypertension who were treated at 50 primary care practices in the Southeastern U.S. More men than women received definitive diagnoses of angina, while more women than men were diagnosed with vague chest pain. Also, women received fewer cardiovascular medications than men.¹

Existing Heart Disease is Undiagnosed in Half of Women Who have a Frst Heart Attack.

Researchers reviewed medical records of 150 women in one Minnesota county who suffered a heart attack over a five year span. Over the 10 years before their first heart attack, the women made a total of 8,732 outpatient visits and had 457 hospitalizations, but only 52 percent of the women had been diagnosed with heart disease.²

Women and Men with Cardiovascular Disease and High Cholesterol may Receive Different Levels of Treatment.

An AHRQ study found that, among people with cardiovascular disease, men have their cholesterol measured more often, are treated more aggressively, and have lower levels of so-called "bad"(LDL) cholesterol than women.

Researchers examined cholesterol management of 243 primary care patients from one academic medical center. The patients had coronary heart disease, cerebrovascular disease (vascular problems in the brain), or peripheral vascular disease (vascular problems outside the heart and brain), as well as high levels of "bad" (LDL) cholesterol. Cholesterol management by either medication adjustments or ODL monitoring occurred at 31.2 percent of women's visits and 38.5 percent of men's visits.³

In this AHRQ study, researchers evaluated differences between men and women in rates of receipt of recommended cardiovascular and diabetes care for enrollees in 10 commercial and nine Medicare plans. In the commercial plans, an average of 73.6 percent of men without a contraindication were prescribed a beta-blocker after a heart attack, compared to only 63.8 percent of women. Three plans in the study had significant male-female differences and all three favored men, ranging from an advantage for men of 23.4 to 40 percentage points.⁴

Insurance Status does not Explain the Disparity in Heart Attack Survival.

An analysis of data on 327,040 men and women enrolled in a national registry of patients revealed that women were less likely to receive aspirin, beta-blockers, intravenous heparin, or nitrate therapies within the first 24 hours of hospital admission after heart attack. They were also less likely to undergo coronary angiography, angioplasty, or bypass surgery, but were more likely to die in the hospital.⁵

Women and Minorities may have Atypical Symptoms when Suffering a Heart Attack or Angina.

ER doctors miss diagnosing about two percent of patients with heart attacks or unstable angina because they do not have the typical symptoms associated with these conditions. When such patients are mistakenly sent home from the ER, they are twice as likely to die from their heart problems as similar patients who are admitted to the hospital. In this study, the misdiagnosed patients tended to be women under the age of 55 or minorities who reported shortness of breath as their chief symptom, instead of chest pain, and/or appeared to have normal electrocardiograms.⁶

Columbia St. Mary's is working to reverse this disturbing trend in women's cardiac care. By taking care of yourself and getting the best healthcare, you can keep yourself from becoming a statistic.

¹ Hendrix, Mayhan, Lackland, Egan, American Journal of Hypertension 2005; 18(8): 1026-32 (AHRQ grant HS 10871).

² Yawn, Wollan, Jacobsen, et al., Journal of Women’s Health 2004; 13(10):1087-1100 (AHRQ grant HS 10239).

³ Persell, Maviglia, Bates, Ayanian, Journal of General Internal Medicine 2005; 20: 123-30 (AHRQ grant T32 HS00020).

⁴ Bird, Fremont, Wickstrom, et al., Women’s Health Issues 2003; 13: 150-7 (AHRQ contract 290-00-0012).

⁵ Canto, Rogers, Chandra, et al., Archives of Internal Medicine 2002;162:587-93 (AHRQ grant HS08843)

⁶ Pope, Aufderheide, Ruthazer, et al., New England Journal of Medicine 2000; 342(15):1094-100 (AHRQ grants HS08843 and HS09446).