In the United States, cardiovascular disease (CVD) is the leading cause of death for women and men. Despite the significant impact of cardiovascular disease on women, awareness and education about female heart disease has always been low. A recent study, based on data from more than two million patients, suggests that women were less likely to be prescribed aspirin, statins, and certain high blood pressure medications than men.
Cardiovascular disease is a group of diseases that affect the heart or blood vessels. It includes high blood pressure (hypertension), coronary artery disease, heart attacks, heart failure, heart valve problems and abnormal heart rhythms. Cardiovascular disease may appear different in men and women, potentially requiring different diagnostic and treatment approaches and leading to different results.
Gender differences in CVD
A general lack of awareness of female heart disease can lead to doctors or patients missing heart attacks in women or delaying their diagnosis. For example, while the frequency of cardiovascular disease tends to be lower in women before menopause than in men, it increases significantly after menopause, while it accounts for about one in three deaths in women.
In addition, many of the “classic” signs and symptoms of cardiovascular disease are based on medical research done largely in men. For example, many believe that chest pain is a typical symptom of a heart attack. But while both men and women can experience chest pain, women are more likely to experience atypical symptoms such as nausea or vomiting, shortness of breath, dizziness or no symptoms. In addition, 64% of women who die suddenly from coronary artery disease had no previous symptoms.
The underlying physiological differences in CVD in men and women can also lead to less aggressive diagnosis and treatment in women. Men more often develop blockages of the main cardiac arteries, while women more often have a disease of the small cardiac arteries (microvascular dysfunction), which can make treatment more difficult. And studies (like this one and this one) suggest that women undergo vital procedures, such as heart catheterizations, less frequently, and later during a heart attack, than men.
Treatments to control and prevent CVD
Many drugs are commonly used both to prevent cardiovascular disease before it occurs and to prevent the worsening of an existing disease.
- Statins: a family of cholesterol-lowering drugs
- Aspirin: one baby aspirin (81 mg) per day is widely recommended for people with established coronary artery disease or those who have had a heart attack
- Blood pressure medications: There are several classes of blood pressure medications, including ACE inhibitors, diuretics, beta blockers, and calcium channel blockers.
Other drugs are used to treat specific types of CVD, such as atrial fibrillation and heart failure.
Are there gender differences in the way CVD drugs are prescribed?
A recent study published in Journal of the American Heart Association investigated whether common CVD drugs were prescribed differently in men and women. The study – which was a meta-analysis or review of data from previously published studies – specifically examined the prescriptions imposed by primary care providers for aspirin, statins, and high blood pressure medications. The authors reviewed 43 studies including more than two million patients. They found that women were much less likely to be prescribed aspirin, statins, and ACE inhibitors (a type of high blood pressure medication) than men.
Although the authors applied careful statistical analysis to data from a large sample of patients, this study has significant limitations. First, the analysis did not take into account the differences in individual cardiovascular diagnoses between women and men in order to determine the appropriateness of drug prescriptions. Second, the study did not examine other common drugs used to treat atrial fibrillation or heart failure. Finally, the study only looked at prescriptions from primary care providers and did not take into account medications that could have been prescribed by cardiologists.
Overall, this study adds to a growing body of literature that women are less likely to be prescribed cardiac drugs recommended by the guidelines. More research is needed to understand why these differences exist, but they are probably related, at least in part, to the underlying gender differences in the cardiovascular diseases discussed above.
What do people need to know to make sure they get the best cardiovascular care?
Everyone, regardless of age and medical history, should regularly see their primary care doctor and be aware of recommended CVD screenings, especially cholesterol, diabetes and blood pressure checks. During these visits, ask your doctor about your individual risk for cardiovascular disease and discuss the risks and benefits to you of cardiovascular drugs. Finally, everyone – except women in particular – should be aware of the signs and symptoms of CVD.
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