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Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
Cardiovascular disease (CVD), which includes coronary artery disease (CAD), hypertension, stroke, and other CVDs, continues to be the leading cause of mortality among both men and women. For women, however, increasing awareness and understanding of how CVD affects them remains a challenge.
Since 1984, the number of deaths in women related to CVD has exceeded that of men.1 In 2004, 459,096 women's deaths were caused by CVD, representing 52% of all CVD-related deaths.2 It is estimated that 42.1 million women in the United States are currently living with some form of CVD, and even more are at risk of developing it.2 CVD is responsible for an estimated 39% of all female deaths in the United States annually; CAD alone accounts for 250,000 deaths.1,3
According to statistics from the Centers for Disease Control and Prevention, CAD claimed the lives of 233,886 women in 2003, compared with 41,566 deaths due to breast cancer.3 Furthermore, results from the Framingham Heart Study conducted by the National Heart, Lung, and Blood Institute (NHLBI) showed that more women than men die within 1 year after having an initial myocardial infarction (MI).4 An estimated 1 in 8 or 9 women in the United States aged 45 to 64 has clinical evidence of CAD, and this increases to 1 in 3 women older than 65.5
Women and CVD: Some Key Findings
Adapted from references 14-18.
In recent years, efforts among health care professionals have been focused on gaining a more thorough understanding of the differences in the pathophysiology, diagnosis, and treatment of heart disease in women, compared with men, as well as promoting an increased awareness about how CVD affects women.1 In a 2004 survey published in Circulation, researchers explored whether physicians knew that more women than men die of CVD each year. The results showed that only 17% of cardiologists, 13% of obstetrician/gynecologists, and 8% of primary care physicians were aware of this fact.6
A growing trend among women in their awareness of CVD has occurred in recent years, however. A 1997 survey conducted by the American Heart Association (AHA) found that only 30% of women perceived CVD as the leading cause of death among women; in 2003, 46% of women did.7 More recently, results from a 2006 AHA survey reveal that 57% of women identified CVD as the leading cause of death among women; however, 21% of women aged 25 to 34 still believe that breast cancer is the leading cause of death.4,8
Study results indicate that men with CVD are more likely to be diagnosed and treated earlier than women. Most clinical studies regarding CVD have primarily involved men, whereas women have accounted for <30% of study participants.9 In addition, although men and women may present with the typical symptoms associated with an MI, an estimated 20% of women present with atypical or unusual symptoms, such as back pain, a burning sensation in the chest, abdominal discomfort, nausea, and/or fatigue.10
Kudenchuk et al showed that women tend to delay seeking medical care for cardiac-related symptoms and are less likely to enroll in cardiac rehabilitation, when compared with men.11 The results of the study also found that women were less likely to undergo diagnostic and therapeutic cardiac procedures.11
Statistics show that 42% of women die within 1 year of a first MI, compared with 24% of men.12 Although the reasons for these differences are not fully understood, on average the first signs of CVD may occur 10 years later in women than in men, and MIs may occur as much as 20 years later in women than in men.4,5 Some studies suggest no evidence of undertreatment of CVD in women, whereas other studies suggest that age and other comorbidities could be leading factors in the differences in mortality rates.12
According to the American Diabetes Association, women with diabetes are 10 times more likely to die from CAD.13 In addition, other studies suggest that conditions specific to women (ie, early menopause, gestational diabetes, etc) may pose an increased risk of ischemic heart disease later in life.12
Clearly, more research on CVD and women is needed. The NHLBI's Women's Ischemia Syndrome Evaluation (WISE) study has enabled researchers to gain a better understanding of evaluating and diagnosing CVD in women. The WISE study found that an estimated 3 million women in the United States have a condition called coronary microvascular syndrome.19 This condition encourages plaque to accumulate in very small arteries of the heart, causing narrowing and reduced oxygen flow to the heart. As a result, the plaque does not show up when physicians use diagnostic coronary angiography. The tests reveal that these women have "clear" arteries and no blockages, thus incorrectly classifying them as low-risk. Many of these women are actually high- risk and go untreated.19
Last year, the AHA updated its Guidelines for Preventing Cardiovascular Disease in Women. The guidelines classify women at various risk levels and provide recommendations for lifestyle modifications and drug therapies appropriate for each level.20
As more research is conducted to learn more about CVD in women, health care professionals should continue their efforts to increase public awareness. Women also should be aware of the signs and symptoms associated with CVD and seek immediate medical attention when needed. Pharmacists can encourage women to discuss their potential cardiovascular risks with their primary health care provider and also to incorporate various lifestyle modifications, such as eating a diet low in fat, maintaining a healthy weight, quitting smoking, and establishing a regular exercise routine when warranted.
To increase awareness about CVD among women, please visit the following Web sites: