Women and Cardiovascular Disease: Disparities In Care
Sudden Cardiac Death and cardiovascular disease is the number one killer of women in the US second only to ALL cancers COMBINED. The prevalence of coronary artery disease in women is similar to that in age-matched cohorts of men– yet women tend to be under-served and under-treated. When we look at specific interventions such as Percutaneous Coronary Interventions (PCI or coronary stenting) and Implantation of Implantable Cardioverter-Defibrillators (ICDs), and advanced devices for Congestive Heart Failure, we find that men tend to have more access to advanced therapies and are undergoing procedures at two to three times the rate of women.
Why is this? Let me offer my two cents:
Typically, married women and women with children in the US today strive to ensure that all other family members are cared for BEFORE considering their own needs. Women often minimize their own symptoms and risks in order to better care for their families. Often, women who work outside the home are very busy and try to perform well at work as well as at home as “Mom”. Diet, exercise and other modifiable risk factors for cardiovascular disease go unidentified or are just plain ignored. Time is at a premium and exercise, cooking healthy meals and preventative care doctor visits are often left off the “to-do” list.
Symptoms in Women with undiagnosed cardiovascular disease are often vague and easily dismissed. Women with CV disease may present differently than men. Rather than chest pain, shortness of breath and nausea, women may present with anxiety, feelings of dread and other vague, non-specific symptoms. This can make diagnosis difficult. Health care providers must be aware of an individual woman’s risk factors for CV disease and interpret the patient’s atypical symptoms within this context. Often, women over the age of 55 see only OB/GYN physicians for their care and do not have a relationship with an Internist or Family Doctor who may be more equipped to deal with such issues.
So, this is a big issue but what can we do about it?
First, we must all work to empower women to take control of their own CV health. Whether you are a health care provider, family member, spouse or co-worker, we must educate women about their risk for CV disease and how they can work to modify their own risk. We must re-double our efforts to actively screen at-risk female patients and remain “tuned-in” to atypical presentations of CV disease. As a cardiologist, I have partnered with OB/GYN providers and have worked to provide them with the tools they need to efficiently screen and assess risk in their patients during an office visit. By working with OB/GYN physicians, we are able to identify women with disease who might otherwise go un-noticed and untreated. As a society, we must continue with education, advocacy efforts and research such as those sponsored by the AHA Go Red For Women campaign next month. Make sure to wear RED next Friday February 3rd to support the cause!