Cardiac disease in women

Women often receive a ‘raw deal' when it comes to certain health issues. There are also tremendous discrepancies between the care received by male and female cardiac patients.

Eight million women in the USA have ischaemic heart disease (IHD) and it is currently the leading cause of female mortalities in that country.  Of the thirty people that die daily of heart attacks in South Africa, ten are women.  In the USA, fifty thousand more women die of heart attacks than men each year.

There has been a reduction in male IHD-related mortalities since 1984.  Mortality rates in women, however, have not reduced and the question is - why?  This is indeed a serious question as women with IHD have a higher risk of dying after heart attacks or suffering a second attack.  Statistics reported by the American Health Association (AHA) show that 38% of women and 25% of men are at risk of dying within one year of their first infarct. 

A number of studies show that women receive less optimal cardiac care than men.  According to a study published in the Annals of Internal Medicine (January 2003), preventative treatments such as aspirin, beta-blockers and cholesterol-lowering medications are still grossly under-utilised in women.  Emergency medical treatment for chest pain is also less commonly implemented. 

Studies conducted by Emory and Cincinnati University Schools of Medicine also indicated that:

• Women took longer than men to arrive at emergency units after developing chest pain
• Women experiencing chest pain are less likely to receive an ECG
• Anticoagulant/blood thinning medication was prescribed later for women 
• Women are less likely to undergo cardiac catheterisation than men (a study of more than 100 000 patients in the USA indicated that 36.7% of women as apposed to 48.3% of men received this investigation after admission)

AHA data established that women comprise only 25% of heart-related clinical research studies.

In light of the above, attention should be drawn to the risk factors associated with female cardiac disease.  These include:

• Smoking - women who smoke are at risk of suffering a heart attack nineteen years earlier than women who do not
• Diabetes - women suffering from diabetes are two to three times more likely to have a heart attack
• High blood pressure - this is common in women who take oral contraceptives, especially if they are overweight
• Sedentary lifestyles - many women spend most of their day sitting down and have little or no leisure time for physical activity
• Obesity - being overweight increases the risk of heart attack
•  Hormone replacement therapy (HRT) use - studies have shown that post-menopausal hormone replacement therapy may, in fact, not have the beneficial cardiac protective effects previously associated with their use

These statistics make it clear that increased awareness and education, even in the medical profession, is necessary.  An awareness of the risks associated with heart disease is key to improved outcomes in women. These are facts we should acknowledge, especially with the high incidence of heart disease in South Africa.  Lets identify the problems before we are forced to deal with their consequences.