‘Gender Gap’ Remains for Heart Attack Treatment, Outcomes

A new study finds that many women don’t receive the same heart attack treatment – or fare as well following treatment – compared with men, reinforcing earlier studies on the same topic.

According to researchers at the University of Michigan Cardiovascular Center, that may stem from the fact that women are less likely than men to have major blockages of their blood vessels.

The international study examined treatment and outcomes for more than 25,000 men and women who had a heart attack or severe chest pain between 1999 and 2006. All the patients in the study received angiograms, where a dye is inserted into your blood vessels through a catheter and an X-ray is taken to measure how well blood is flowing.

The study found that women were two times as likely to have angiogram results of “normal” or “mild” – with relatively small blockages in their blood vessels – despite other tests that showed those women were having heart attacks or a form of chest pain.

Women were less likely to receive drugs that would prevent future heart problems than men with the same type of heart disease, researchers found. Regardless of the seriousness of their heart problems, women also were less likely than men to receive stents or angioplasty to open blocked blood vessels. Six months after their initial heart attack or chest pain, women in the study with serious coronary artery disease were more likely to have died or have been hospitalized again.

“We’ve made great strides in treating women with heart disease, but these data show there’s still much to be done – and that we need to find out whether women might have blockages that are ‘invisible’ on angiograms,” says Kim Eagle, M.D., FACC, the study’s senior author.

Women are also more likely than men to have non-standard heart attack symptoms such as jaw pain and nausea, according to the study.

Amy Tucker, M.D., Associate Professor of Medicine at the UVA Health System, says the types of blockages are one possible reason why women don’t receive the same heart care as men.

Coronary disease in women is more likely to be diffuse, or spread out through their blood vessels, Tucker says, while men are more likely to have concentrated blockages in their major arteries. Diffuse coronary artery disease, she says, is less likely to respond to invasive treatments such as angioplasty or bypass surgery.

But there are several other factors also at work, she says. “There is still under recognition of coronary disease in women, in part from the misperception that it is a disease of men and in part because women present more frequently with atypical symptoms,” Tucker says. “Women tend to be older, and to have more cardiovascular risk factors and co-morbidities when they present with acute coronary syndromes, increasing the risk of complications from invasive therapies.”

“However, even excluding these explanations, women with known coronary disease are undertreated, receiving medications for which there is demonstrated benefit to them, such as cholesterol-lowering statins and beta blockers, less frequently than men. The reasons for such undertreatment are not clear,” Tucker adds.

What steps can women take to reduce their heart disease risk? Tucker advocates:

• Maintaining an ideal body weight with help from a heart friendly diet
• Exercising daily
• Avoiding smoking
• Maintaining healthy blood sugar, cholesterol and blood-pressure levels