By Carl Hartman, M.D.
Last month was “Heart Month” on the calendar. This provides a nice opportunity to raise awareness of heart disease, which remains the number one killer for both men and women in this country. Recent media coverage underscores the prevalence of this disease in our society as we have heard about Bill Clinton and Dick Cheney’s hospitalizations this month and the very tragic story coming out of the Winter Olympics in Vancouver where the mother of women’s figure skater, Joannie Rochette, died unexpectedly of a heart attack. Everyone, to varying degrees, is at risk for heart disease.
But rather than make this another column about heart disease as a global topic, I want to address some of the research that points to a disparity among heart disease diagnosis and treatment in men versus women. In other words, when it comes to heart disease is it really Mars vs. Venus?
As a medical doctor, I can say with certainty that there are many differences between men and women. I would guess that very few people – doctor or not – would disagree with that statement. As a practicing cardiologist, I would suggest that I do not see a gender bias in the recognition and treatment of heart disease in men versus women. There are, however, many colleagues within this community and beyond who might beg to differ.
My article concept was prompted by medical studies conducted over the better part of 20 years that suggest women with heart disease are treated less aggressively than men. This results in fewer cardiac catheterizations and bypass surgeries for women. Some research also suggests that women are not given equal access to the tests that help determine heart disease.
A 2007 study conducted by Rand found women insured by Medicare were 22 percent less likely to receive drugs to control cholesterol and guidance after a cardiac event. Among the privately insured, women with heart disease were 15 percent less likely to have the recommended drug treatment, a beta blocker, after a heart attack. These are established treatments for reducing morbidity and mortality.
More recent studies do show some movement on this issue and it appears that the gender gap may be closing, but reports of disparity still exist.
Information like this causes any cardiologist to ask the question of themselves: Do I see a disparity as I look at my practice? My personal answer is no. I think that while differences exist in men and women, heart disease is the same for both and can be dealt with in a similar fashion.
To consider the issue fully, one must look at a greater context. Heart disease tends to be diagnosed earlier in men (typically in their 50s or 60s) than in women (typically in their 70s or 80s). As the disease progresses in patients and requires greater intervention to include cardiac catheterization and bypass surgery, men again skew younger than women. Perhaps this is more a question of tolerance for the procedure; the size of the heart and blood vessels; or a difference in disease severity and not connected to patient gender.
When a heart attack happens, there is much research that suggests the symptoms vary in male and female patients. For women these symptoms can include jaw pain, cold sweats, nausea, and shortness of breath. Symptoms of a heart attack can continue for hours, days, or even weeks.
Some of the more “classically” labeled heart attack symptoms of pressure and pain in the chest and pain in the left arm are seen more typically in male patients. I often hear from my patients - both men and women – that what they thought was indigestion that would not go away was actually a heart attack.
Despite the differences, some things remain constant no matter what your gender. Controlling heart health can best be accomplished through a healthy diet and exercise. Smoking is a common and very controllable risk factor. Quitting now will reduce your risk no matter how long you have smoked. Knowing your family history and having your cholesterol and blood pressure checked will help doctors determine your risk for heart disease and the best approach for controlling or preventing it.
One additional fact that cannot go unmentioned: if you suspect you are having a heart attack, call 9-1-1. Emergency Medical Responders are best equipped to begin treatment at the scene, giving you the best chances of survival. And no matter where one falls in the Mars/Venus debate, survival is a goal we can all agree upon.
Carl Hartman, M.D. is a board certified cardiologist practicing with Cardiovascular Associates. He serves as the medical director of Cardiac Services at Sentara Heart Hospital in Norfolk, Virginia. Dr. Hartman is also an Associate Professor of Medicine at Eastern Virginia Medical School. He received his Doctor of Medicine (MD) degree at State University of New York at Syracuse and completed his postgraduate training at Duke University.