IN THIS ISSUE

From the Summer 2005 Issue

Cardiovascular News

Men and Women: Differences in Heart Disease

You may think that heart or blood vessel disease (cardiovascular disease) usually affects overweight, middle-aged men. If so, you're not alone. Most people are surprised to learn that:

• More women than men die each year from cardiovascular disease (CVD).1
• More women die from CVD than from any other cause, including all types of cancer combined.2

Now recent studies offer new information about CVD differences in men and women. The fact is, blocked arteries can develop differently in women than in men. Women can also have different symptoms of some heart problems, such as a heart attack.

"In the last 25 years while cardiovascular death rates were falling for men, they were rising for women," noted Beverly Lorell, MD, vice president and chief medical and technology officer of Guidant. In fact, half of all women in the United States die from CVD.2

How CVD Develops

CVD begins when cholesterol in the blood collects in the arteries, forming plaque. As plaque builds up, it can block the arteries and cut off the blood flow and oxygen supply to parts of your body.

Over time, plaque buildup can lead to:

• Heart attack—Caused by blocked coronary arteries on the surface of your heart
• Stroke—Caused by blocked carotid arteries in your neck

What the New Studies Show

A number of studies point to new facts about women and CVD. These facts are changing the way doctors evaluate and treat their female patients.

New Fact: Biology May Play a Role

One major government-sponsored study3 found that women may develop CVD differently than men:

• Plaque often builds up in one or two areas in men's arteries. But it is more likely to build up throughout women's arteries.
• Men's blockages are usually in larger coronary arteries. But women's blockages are often in smaller coronary arteries.

The medical test created to find blocked arteries was based on older CVD studies, which focused mostly on men. That test, an angiogram, is a special x-ray that shows arteries. An angiogram more clearly shows blockages in larger arteries—which are more common in men. So with this traditional test, women's CVD can be harder for doctors to see.

"In many cases, women should perhaps be sent for other types of tests," said Dr. Lorell. "A perfusion study, or an echocardiogram during a treadmill test, might better identify a woman's CVD."

New Fact: Hormones Don't Always "Protect" Women

It's true that the hormone estrogen helps protect some women against CVD. And it's true that heart attacks and strokes are more common in women after menopause—when estrogen levels are lower—than in younger women.

"Doctors used to think that women in general were protected by estrogen before menopause," Dr. Lorell noted. "We now know that hormones alone do not protect women before menopause. And estrogen therapy seems to increase the risks of coronary disease after menopause. We know that women in their 20s to 50s aren't immune from CVD. It's absolutely incorrect that women and their doctors can avoid talking about prevention of heart disease until menopause."

Since hormones alone do not protect women from CVD before menopause, "lifestyle changes are especially important in lowering women's risks," said Dr. Lorell.

Women and CVD Treatment

A 2004 survey4 explored whether doctors knew that more women than men die every year of CVD. Only 17% of cardiologists, 13% of obstetrician/gynecologists, and 8% of primary care doctors knew that fact.

"It's striking that fewer than one in five doctors knew how common CVD is in women," said Dr. Lorell. But the good news is that the new studies are making it easier for doctors to learn more about how CVD is different in men and women.

Researchers have also learned that more women have heart attacks that go unrecognized by healthcare workers. Treatments for CVD are as effective for women as for men. Yet women are less likely to get treatment such as cardiac devices, stents for blocked arteries, or bypass surgeries.

"In some ways the gap has narrowed in giving similar treatments to men and women," said Dr. Lorell. "For example, both women and men usually receive the same medications for heart failure. But we know that women are less likely to receive newer therapies such as life-sustaining devices like implantable cardiac defibrillators."

Awareness Leads to Action

According to Dr. Lorell, "We now know a lot more about women's and men's heart disease. Both doctors and patients can take that information and put it to use to both prevent heart disease and recognize it early when it occurs."

Before the recent studies, doctors' understanding of CVD—its symptoms, when to diagnose it, how to treat it—was based mostly on white, middle-aged men. That's because nearly all studies of CVD looked mostly at white, middle-aged men.

Dr. Lorell explained that today many studies attempt to include equal numbers of women and men. And to make up for lost time, some studies focus just on women and CVD. Many of these studies are still going on. When the studies are finished, "doctors will know even more about how CVD develops in women," commented Dr. Lorell. "In turn, doctors can do a better job of diagnosing and treating heart disease in both women and men."

Dr. Lorell stressed that both women and men need to "take ownership of their health. Consider making changes—quit smoking, get daily exercise, and eat a healthy diet. I can't emphasize enough how important it is to adopt a healthy lifestyle."

1. The National Coalition for Women with Heart Disease. Mortality chart. Available at http://www.www.womenheart.org/information/women_and_heart_disease.asp. Accessed November 7, 2006.
2. National Heart, Lung, and Blood Institute. Healthy heart handbook for women. Available at http://www.nhlbi.nih.gov/health/public/heart/other/hhw/. Accesssed November 7, 2006.
3. National Institutes of Health. WISE study defines women's heart disease. Available at http://www.ncrr.nih.gov/newspub/apr03rpt/stories2.asp. Accessed November 7, 2006.
4. Mosca L, Linfante AH, Benjamin EJ, et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circ. 2005;111:499-510.

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