Cardiovascular Disease Prevention in Women
Cardiovascular disease (CVD) affects more women than men and is responsible for more than 40% of all deaths in American women. While the prevalence of CVD in women has been known for some time, most research studies, and resulting therapeutic recommendations, have focused on men. Recently, however, research on women has shown the following:
- One in two women in the United States dies of ]]>heart disease]]> or ]]>stroke]]> , compared to 1 in 30 from breast cancer.
- 38% of women die within one year after having a heart attack.
- Within six years of having a heart attack, about 46% of women become disabled with heart failure.
- Two-thirds of women who have a ]]>heart attack]]> fail to make a full recovery.
Additionally, previously published studies have found that women have worse CVD outcomes than men and, furthermore, that despite education campaigns and national guidelines that contain female-specific information, women do not receive optimal CVD preventive care. A study published in the February 1, 2005 issue of Circulation examined if preventive care for CVD—in light of the well-accepted data on its prevalence in women—varied by patient gender among different physician specialties.
About the Study
The study was conducted through an online questionnaire sent to 500 randomly selected physicians: 300 primary care physicians (PCP), 100 obstetricians/gynecologists (OB/GYN), and 100 cardiologists. The questions were designed to measure the physicians’ awareness and adoption of national CVD guidelines, as well as possible barriers to adoption of the guidelines.
The researchers also gave participating physicians 10 patients profiles with varying levels of CVD risk and asked them to, first, assign a level of risk to each case, and second, specify their preventive treatment recommendations, whether physical activity, dietary counseling, dietary supplements, aspirin therapy, etc.
The results showed that there was a high level of awareness of the national prevention guidelines, especially among PCPs and cardiologists. However, only about half of the cardiologists and PCPs who knew of the guidelines were actually incorporating them into their practices, and less than 30% of OB/GYNs were.
The study also found, not surprisingly, that a physician’s assessment of a patient’s CVD risk level significantly influenced the degree of prevention recommendations he or she made. According to the study, less than two-thirds of physicians recommended physical activity to low risk patient profiles and roughly half suggested dietary counseling. On the other hand, intermediate and high risk patient profiles merited recommendations including physical activity, cardiac rehabilitation, dietary therapy, weight reduction, blood pressure control, cholesterol management, and aspirin therapy.
This coupling of risk assessment and prevention recommendations is especially significant in light of another finding: women were more likely than men to be assigned to a lower-risk category despite a similar actual risk. In fact, patient gender had a significant influence on doctors’ assignments of risk category. Additionally, despite education campaigns about women and heart disease, less than one in five of the surveyed doctors knew that CVD kills more women than men each year.
How Does This Affect You?
At first glace, these findings seem alarming. But, this study does have several limitations based on its design. The study was a questionnaire that was given online. Physicians logged onto a website to answer the questions. Could physicians who are computer-savvy and willing to take a survey treat patients differently than physicians who aren’t interested in completing an online survey? Possibly.
Also, once physicians completed a survey question, they could not return to previous questions. This is not how medicine is practiced. Medicine is an iterative process; one where a patient provides feedback to the physician and the physician can adjust treatment accordingly. Additionally, although responding to written case studies is frequently used as a teaching device in medical school, it isn’t necessarily indicative of how a physician actually practices medicine. Physicians routinely gather information during the physical examination and patient interview that influences ultimate treatment decisions.
Although the study’s design calls its findings into question, the study does raise an important question: Are physicians treating women at risk for CVD less aggressively than men? According to this study’s authors, the answer is yes. The next question, of course, is to ask why.
These findings were echoed by a second study published in the same journal. This study looked at more then 8,000 women who had established CVD or were high-risk because of diabetes or other serious risk factors. The women’s cholesterol levels and prescriptions for cholesterol-lowering medication were followed for up to three years. Cholesterol drug therapy was started in just 32% of patients. A mere 7% met their cholesterol goals initially, and after 36 months, that number increased only slightly to 12%. The authors concluded that among high risk women, only one-third are receiving the recommended drug therapy to help prevent CVD, and of those that do, few are achieving recommended cholesterol levels.
American College of Cardiology
American Heart Association
National Heart, Lung, and Blood Institute
Women's Heart Foundation
Healthy Heart Handbook for Women. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/other/hhw/hdbk_wmn.pdf . Accessed February 1, 2005.
Mosca L, et al. National study of physicians awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005;111:499-510.Mosca L, et al.
Opportunity for intervention to achieve American Heart Association guidelines for optimal lipid levels in high-risk women in a managed care setting. Circulation. 2005;111:488-493.
Women and Heart Disease. Texas Heart Institute. St. Luke's Episcopal Hospital Web site. Available at: http://www.tmc.edu/thi/women.html . Accessed February 1, 2005.
Last reviewed Feb 3, 2005 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.