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Women's heart disease: It's the leading killer, but patient care lags that for men: As cardiac science advances, women find treatment lagging

McClatchy-Tribune Information Services -- Unrestricted

12-29-08

Heart disease is the leading cause of death for women in the U.S., yet a wealth of data shows female cardiac patients receive inferior medical care compared with men.

Too many physicians still discount the idea that a woman could be suffering from heart disease, delaying or denying needed medical interventions, experts note. Most community hospitals in the U.S. still are not following guidelines for treating women with heart attacks. And primary care doctors don't do as much as they could to emphasize prevention.

As a result, women are failing to reap the full benefits of enormous advances in cardiovascular medicine.

The point was underscored this month by a study published in the journal Circulation finding that women who have heart attacks receive fewer recommended treatments in hospitals than men, including aspirin, beta blocker medications, angioplasties, clot-busting drugs and surgeries to re-establish blood flow. Women with the most serious heart attacks, known as STEMIs, were significantly more likely to die at a hospital than men.

"We need to do a better job of defining women's symptoms and treating them aggressively and rapidly, as we do for men," said Dr. Hani Jneid, the study's lead author and assistant professor of medicine at the Baylor College of Medicine in Houston.

In Israel, when guidelines have been applied much more rigorously, the mortality difference between the sexes all but disappeared, according to a July study in the American Journal of Medicine.

Outside hospitals, too few internists, family doctors, obstetricians and gynecologists are implementing recommendations for preventing heart disease in women, experts say. Eighty percent of heart attacks in women could be prevented if women changed their eating habits, got regular exercise, managed their cholesterol and blood pressure, and followed other preventive measures.

Although death rates from cardiovascular disease have fallen, the condition killed 455,000 women in 2006, according to data from the American Heart Association. Heart disease causes about 72 percent of cardiovascular fatalities; the rest are strokes and other related conditions.

The next decade could see major advances as scientists better understand how the biology of heart disease differs in women, said Dr. Joan Briller, director of the Heart Disease in Women program at the University of Illinois Medical Center at Chicago.

Already, for example, researchers have learned that plaque deposits tend to be spread more widely in women than in men, resulting in fewer big blockages in the arteries. That means standard therapies such as angioplasty are often less effective in women. Also, woman metabolize certain heart drugs at a different rate than men.

Women should learn about the symptoms of acute heart disease -- which can differ from those in men -- respond promptly if they sense something is wrong, and "find physicians who care about them," said Dr. Annabelle Volgman, medical director of the Heart Center for Women at Rush University Medical Center.

"Ask your doctor: Are you familiar with the guidelines for the prevention of heart disease in women published in 2007? Do you follow them? If they say 'no,' find yourself another doctor," she said.

These Chicago-area women learned the importance of that advice the hard way: To see more of the Chicago Tribune, or to subscribe to the newspaper, go to http://www.chicagotribune.com. Copyright (c) 2008, Chicago Tribune Distributed by McClatchy-Tribune Information Services. For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

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