Women and Heart Disease Megan McCarren and Valerie HackerPacific Lutheran UniversityNovember 2007
Heart Disease Is Not Just A Man’s Disease • Since 1984, the number of deaths for women has exceeded those for males. Source: AHA Heart and Stroke Statistical Update, 2003
More Facts • More women in every age group die from heart disease than breast cancer • One in two women will die of heart disease (breast cancer is one in ten) • Two-thirds of women who die from a heart attack, have no previous symptoms of the disease • Women die twice as often after a heart attack as compared to men
Why do Gender Differences Exist? • Most of the research on heart disease has been done on men. • Physiological differences between men and women leading up to a heart attack • Symptoms are different between men and women • Problem of awareness and perception
How are Women Different? • Anatomy: Smaller heart arteries • Physiology: Estrogen has a protective effect in women • Pathology: Less likely to have total blockage of heart arteries
Are there Differences in Risk Factors? • Cholesterol Level- High cholesterol more common in older women than men • Blood Pressure– Pregnancy and some BCPs can increase risk of high blood pressure • Diabetes- Increases heart disease risk in women up to 7 times (men up to 3 times) • Smoking- Combination of smoking and BCPs increases risk • Age- women experience symptoms 10 years later • Physical inactivity- osteoporosis and other age-related conditions may limit ability to exercise
How are Women’s Symptoms Different? • Women may have “typical” or “atypical” symptoms typical: crushing chest pain traveling down the left arm, nauseaatypical: shortness of breath, abdominal pain indigestion, fatigue • Atypical symptoms lead to delays in treatment because the symptoms are vague and associated with other medical conditions • Delayed treatment often means poorer outcomes
Denial is Part of the Problem • Women will show up one hour later to the Emergency Room, as compared to men • Women are less likely to complain of “heart attack” symptoms • Women will continue activities when feeling ill • The bottom line: women are less likely to seek rapid and appropriate care when their symptoms start. This causes significant delays in treatment.
Are There Gender Differences in Care? • Compared to men, women are:-7% less likely to receive clot dissolving drugs during the first hour of heart attack treatment-6% less likely to receive aspirin within the first 24 hours of hospital care-More likely to receive a “do not resuscitate” order • Some diagnostic tests and procedures, including the exercise stress tests, are less accurate in women.
What is Needed to Bridge the Gender Gap? • Need more gender-specific research and development of clinical guidelines • Women need to demand that there be more gender specific care • Need more gender-specific diagnostic testing (example: 80 lead EKG)