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April 2005 Issue

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Women Shortchanged on Cardiac Care, Study Shows

Published April 2005

Although more women than men have died of cardiovascular disease since 1984, a multicenter study led by a UC scientist suggests that women are less likely than men to receive the recommended treatments and procedures for heart disease.

Published in the March 15 Journal of the American College of Cardiology, the study is a continuation of work reported last year at the American College of Cardiology (ACC) Scientific Assembly in New Orleans.

Principal investigator Andra Blomkalns, MD, director of the emergency medicine residency training program at the College of Medicine, says that while treatment of heart patients overall is improving, the benefit does not seem to translate to women.

Fortunately, however, although the women in the study did not receive recommended treatments as frequently as men, there was no difference in their death rate or other health outcomes.

Dr. Blomkalns and her team, which included Brian Gibler, MD, chairman of the Department of Emergency Medicine, studied nearly 36,000 women around the country with a heart condition known as non–ST-segment elevation acute coronary syndrome. Women make up 40 percent of patients with this condition, and their risk of complications is 15 to 20 percent higher than that of men.

Yet even though the researchers took into account age, disease severity and other factors linked with less aggressive treatment, they still found women were receiving less than "guideline" treatments recommended by the ACC and the American Heart Association (AHA).

"I feel that clinicians, and even patients, don't believe that women have the disease," says Dr. Blomkalns. "Coronary heart disease has been seen as a 'man's disease' for so long that the attitudes, therapies and interventions haven't been thought of as gender neutral. Women likely present somewhat differently with their symptoms, and the tests we use to find heart disease might need to be chosen and interpreted differently for women."

The fact that the researchers found no apparent difference in death rate compared with men, Dr. Blomkalns says, "is the topic of more research. It just shows that women and men are different when it comes to heart disease. They present and act differently when they are treated. We haven't begun to understand the implications of these differences."

UC and University Hospital are col-laborating with over 400 hospitals led by Duke Clinical Research Institute, Durham, N.C., in a nationwide quality-improvement initiative known as CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Imple-mentation of the ACC and AHA Guidelines).

CRUSADE is funded by Millennium Pharmaceuticals Inc., Cambridge, Mass., and Schering-Plough Corp., Kenilworth, N.J. A partnership of Bristol-Myers Squibb, N.Y., and Sanofi Pharmaceuti-cals, N.Y., provided additional funding.

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