Women's hearts need extra attention
Does sex matter? The national Institute of Medicine asked that question about human health. The answer, of course, is yes. Nowhere are the differences between men and women more apparent than in matters of the heart.
Women's hearts are built from the same general blueprint as men's and pump blood along the same circuit. But small variations in anatomy and physiology interacting with differences in behavior and culture mean that heart disease in women isn't always diagnosed or treated as promptly or thoroughly as it is in men. New findings reinforce the disparities.
Mystery chest pain. Women are more likely than men to be hospitalized for chest pain that can't be traced to a particular cause. One hundred thousand more women than men left a community hospital in 2006 with a diagnosis of "unspecified chest pain."
Emergency delays. In Dallas County, Texas, emergency crews responding to 911 calls took almost the same amount of time to get women with chest pain to the hospital as men. But women predominated in the 11% of cases that took far longer than the average. The delays could have stemmed from less certainty the heart was in danger, more time spent assessing the condition, or because the condition didn't seem urgent to the emergency crew.
Heart attack and angioplasty. The American College of Cardiology collects data on how heart attack patients are treated at various hospitals around the country. The database shows that women are more likely than men to experience complications from a heart attack (like shock or heart failure) or from the angioplasty used to halt it. They are also less likely to be discharged from the hospital with prescriptions for aspirin, for another key anti-clotting drug called clopidogrel (Plavix), or for an artery-protecting statin. In a different survey of men and women being treated for heart attacks at 420 U.S. hospitals, it took longer for women who qualified for angioplasty to undergo this key treatment to halt the heart attack.
Physician gender. In a study from Germany, female physicians were more likely than their male counterparts to prescribe evidence-based drug therapy to people with heart failure. Female physicians prescribed beta blockers and ACE inhibitors at the same rates to men and women, while male physicians prescribed fewer medications at lower doses to women. A male patient treated by a female physician tended to get the best care, at least in terms of recommended medications, while a female patient treated by a male physician got the worst care.
Getting great care
There's a thin silver lining in findings like these: they etch the scope of a problem that went unrecognized when heart disease was erroneously considered a "man's disease." Now that we know it's an equal-opportunity disease, the next step is making it an equally treated disease.
That will take some doing. We still need to know more about how women's hearts differ from men's, how they age, and how they respond to diet, exercise, hormones, stress, and other influences. A new generation of doctors who cut their teeth knowing that women and men are different when it comes to heart disease will also help.
In the meantime, keep in mind that women don't always have the "classic" signs of a heart attack. It's also important to seek the best care possible. Find a physician who listens to you and takes you seriously, someone who doesn't brush off your physical problems as "stress."
If you don't think you are getting the treatment you need, consider a doctor who practices at a center that specializes in women's health. The U.S. Department of Health and Human Services has designated 20 National Centers of Excellence in Women's Health. Scores of others are flourishing around the country.
Common heart attack symptoms in women
Women may have all, many, a few, or none of the "typical" heart attack symptoms doctors look for. In women, as in men, the most common symptom of a heart attack is some type of pain, pressure, or discomfort in the chest. But women are more likely than men to have symptoms unrelated to chest pain, such as:
May 2009 update