Knowledge is the Key
"1 in 5 females has some form of cardiovascular disease."
- American Heart Association (AHA), 2003
Misunderstood and Deadly
For most women, the threat of breast cancer is very real - the fear of osteoporosis tangible. Awareness of these diseases has increased over the years due in part to massive research and education dollars. Many women now understand the importance of a mammogram and the benefit of strong bones. But what about heart disease?
The Biggest Killer
Women and their physicians simply do not understand the pervasiveness of cardiovascular disease (including heart disease, heart attack and stroke). They do not understand that one out of every 2.7 deaths in women can be attributed to this killer. The Society for Women's Health Research notes that, "one out of three primary care physicians surveyed did not know that CVD is the leading cause of death among American women."
Women Not the Focus
There may be some historic reasons for this aberration. For instance, recent reports suggest that research into coronary heart disease (CHD) has either excluded women entirely or when including them has failed to analyze by gender. An August 2003 article in ADVANCE magazine summarized a report by the Agency for Healthcare Research and Quality by saying that "in the last 20 years, the diagnosis and treatment of CHD has often excluded or underrepresented both women and minorities, and as a result, the tests and therapies used to treat women with CHD are based on studies conducted predominately in middle-aged men." As a result when a woman visits her physician he may make recommendations based on inadequate evidence-based data.
Under-diagnosed & Under-treated
"Seventy percent of women surveyed said their doctors did not discuss heart disease with them when discussing overall health"
- The Society for Women's Health Research
Women who are premenopausal benefit from the effects of estrogen, which typically provide women natural protection against heart disease.
1. Women have more non-cardiac chest pain than men.
2. Women typically develop heart disease up to 10 years later in life than men.
3. Women who develop heart disease later in life may be difficult to diagnose because of other chronic conditions.
4. Women typically experience their first heart attack 20 years later than men (and when they do it is generally more severe).
5. Women can present with subtle heart attack symptoms such as indigestion, abdominal or mid-back pain and vomiting.
Sobering Statistics
"Experts speculate that delayed detection coupled with less aggressive care may partly explain why women with heart disease fare worse than their male counterparts," states The Society for Women's Health Research. In fact women receive only 33% of all angioplasties, stents and bypass surgeries; 28% of implantable defibrillators; and 36% of open-heart surgeries. And according to the AHA, 65,000 more women than men will die of CVD related diseases each year. So how can all this be changed?
Early detection and prevention efforts combined with management of risk factors can begin to turn these statistics around.
Diagnostic Techniques
Not all diagnostic tests are as reliable for women as they are for men. As an example in women, hormones and breast size can affect the specificity and/or the sensitivity of certain tests. Yet today there are several different imaging exams that can be employed, offering physicians options to properly assess a woman who presents with suspected heart disease symptoms. And Philips imaging technology leads the way in each:
ECG
An electrocardiogram that measures and records the electrical activity of the heart is often the first exam prescribed - either in rest or stress mode. The resting ECG is very effective in men but can provide some false positive results in women. Similarly, ECG stress tests are useful for men but possible false positive and false negative results make it less so for women.
Stress Echo
Stress echocardiography can be a better alternative than ECG for women, with an almost 90% accuracy rate. It affords a rapid, noninvasive, and dynamic profile of the heart for many conditions and is used to diagnose coronary artery disease by detecting cardiac wall motion abnormalities.
Nuclear Med/PET
Stress nuclear imaging can serve a complementary role to x-ray angiography by examining exercise tolerance and to identify areas of inducible ischemia. A recent article in ADVANCE magazine states that, "Radionuclide perfusion imaging, in particular, combined with either exercise or pharmacological stress testing, can identify cardio vascular disease risk in women." PET offers similar rest-stress data and is superb for identifying viable myocardium.
MRI
Increased attention is being placed on Magnetic Resonance Imaging due to the absence of radiation and its ability to non-invasively and directly assess coronary artery integrity.
Prevention - The First Line of Defense
Women can do a lot themselves to prevent the onset of cardiovascular disease - they can learn to control risk factors.
Just as important, it is incumbent upon physicians to ensure proper education for their patients and to provide thorough testing.
Controllable Risk Factors
Making lifestyle changes to improve heart health is a woman's priority. Controllable risk factors include:
1. Eating well - A low sodium, low fat diet can help produce cholesterol and high blood pressure.
2. Stop smoking - Smoking leads to increased risk of CVD. According to the AHA, "Women who smoke are two to six times as likely to suffer a heart attack as non-smoking women."
3. Avoiding stress - Stress can lead to bad habits like smoking, drinking and overeating.
4. Increasing physical activity - Regular exercise can help produce weight and improve blood flow to the heart.
Be proactive!
Women should take charge of their health. As is evident, the medical community can fall short - missing out on critical differences in the sexes. Women must be empowered to learn, question and act.
Knowledge is the key to good health.
(Published September 1, 2004)