Women Lag in Heart Disease Detection

They get fewer important tests compared to men, study finds

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By Janice Billingsley
HealthDay Reporter

THURSDAY, Nov. 10, 2005 (HealthDay News) -- Although heart disease remains the number one killer of women, female patients with cardiovascular symptoms are still less likely than men to receive tests to assess their heart health, a large Canadian-led study has found.

The results of a 28-country study of more than 12,000 men and women found that women, particularly those at high-risk for coronary disease, were being under-treated at hospitals. This means that more women than men end up back in the hospital within a year with coronary disease symptoms, said lead author Dr. Sonia Anand, an associate professor of medicine, McMaster University in Hamilton, Ontario.

Compared with men, women "don't have a higher rate of heart attack, stroke or death, but they do have increased rates for refraction [treatment-resistant disease] and for unstable angina," she said. "They haven't been fixed."

The study results appear in the Nov. 15 issue of the Journal of the American College of Cardiology. Anand also discussed the findings Thursday at the American Medical Association's 24thannual Science Reporters Conference in Washington, D.C.

For the study, Anand and her colleagues analyzed data from a previous study she had worked on, called the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial. That trial followed more than 4,800 women and 7,700 men from 28 countries hospitalized with heart disease at some point between 1998 and 2000.

The data included follow-up visits to the hospital up to one year after admission. All the patients had been diagnosed with acute coronary syndrome (ACS), a common group of heart conditions that includes chest pain and certain types of heart attacks.

The women were overall slightly older than the men and had higher rates of diabetes, hypertension and cholesterol levels, while more of the men were smokers, had a prior history of heart disease and higher incidence of stroke.

The average time between when the symptoms appeared and the patients sought help was the same for both genders, as were the percentages of patients taking aspirin, cholesterol-lowering statins or antihypertensive beta-blockers, all medicines aimed at reducing heart disease risk.

However, Anand found that the women -- no matter how high their risk for ACS -- were significantly less likely than the men to undergo aggressive testing to assess their heart health. Overall, 15 percent fewer women than men underwent coronary angiography -- an X-ray of the blood vessels or chambers of the heart to identify blockages. Among patients considered to be high risk for heart disease, 20 percent fewer women than men had the test.

Failure to undergo angiography can have serious consequences, the researchers noted. Because they so often did not have the test -- which indicates when other aggressive treatments are advisable to treat serious illness -- women were 35 percent less likely than men to undergo angioplasty or coronary artery bypass surgery, procedures which can restore healthy blood flow to and from the heart.

"By not doing more coronary angiography in the high-risk group of women, we're under-treating women who would benefit from it," Anand said.

She said the reasons for the discrepancy between men and women in testing could be varied, from a bias on the part of the physicians who assume women are less prone to heart attacks, to a tendency among women to attribute their heart disease symptoms to other causes, such as gastrointestinal problems.

But Anand said that, regardless of the reasons, the study shows that by assessing heart-disease risk according to the widely used Thrombolysis In Myocardial Infarction (TIMI) score, doctors could easily identify high-risk women who would most benefit from coronary angiography.

"Physicians should use this simple tool to classify women by risk of serious coronary disease and send all high-risk women for an angiography," she said.

At the same time, women who are admitted to the hospital with chest pain should be proactive as well, Anand said.

"A woman should ask, 'Am I a candidate?', which at least gets the physician to talk about it," she urged.

The findings are "a great disappointment," said Dr. Nieca Goldberg, chief of women's cardiac care at New York City's Lenox Hill Hospital and author of the heart-health book Women Are Not Small Men.

"When patients come to the hospital, we should not really focus on their gender, but on what's really happening to them," said Goldberg, who works with the American Heart Association on its "Go Red for Women" program to raise awareness among women on their risk for heart disease.

Doctors treating women for potential heart disease should be diligent in looking for atypical symptoms that are often more common in women than men, she said. These include reports of shortness of breath, unexplained fatigue and pressure lower down on the body, rather than in the chest.

More information

For more on women's heart health, head to the American Heart Association.

SOURCES: Sonia S. Anand, M.D., PhD., associate professor, medicine, McMaster University, Hamilton, Ontario, Canada; Nieca Goldberg, M.D., chief, women's cardiac care, Lenox Hill Hospital, New York City; Nov. 15, 2005, Journal of the American College of Cardiology

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