Cardiology Express Report
American College of Cardiology
Anaheim, CA

Women with Heart Disease Face Tougher Battles than Men

This report was reviewed for medical and scientific accuracy by William H. Stuart, MD , Director,Multiple Sclerosis Center of the Shepherd Center, Founding Partner Peachtree Neurological Clinic, Medical Director for Rehabilitation Services, Piedmont Hospital, Atlanta,GA; Chairman, HealthMed Advisory Board, .

Several studies presented at the recent meeting of the American College of Cardiology held in Anaheim, California suggest that women with heart disease are generally older, sicker, and more likely to die from their heart condition than their male counterparts. One study showed that although a procedure used to treat heart attack patients was equally successful in opening the clogged arteries of men and women, women experienced more complications than men after the procedure and required more repeat procedures, including open-heart surgery.

The study conducted over a five year period included 2,584 people (723 females and 1,861 males) in Australia who underwent balloon angioplasty-a procedure used to open clogged arteries-found that twice as many women needed a repeat procedure or cardiac bypass surgery during hospitalization for the initial angioplasty procedure, and there were twice as many complications involving blood vessels in women compared to men.

The women in the study were about ten years older than the men, and had a higher incidence of high blood pressure, diabetes, and obesity, but a lower incidence of smoking and left heart dysfunction. These differences, however, did not account for the greater number of complications in women or the need for repeat procedures to open the women's arteries. The Australian study was reported by Dr. Patrick C.H. Ang of Monash University, Melbourne, Australia.

A second study, reported by New York City cardiologists Dr. David L. Brown and Dr. Babak A. Vakili of Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, found that women who have a heart attack and are treated by balloon angioplasty are two-and-a-half times more likely to die than men who have the same procedure for the same reasons. In this study, the women arrived at the hospital with worse symptoms and had a much higher chance of dying than the men before being discharged from the hospital. This study included 1,044 patients (317 females and 727 males) who had angioplasty for an acute heart attack. As in the previous study by Dr. Ang, the women were sicker than the men-they were older and more of them had high blood pressure and diabetes. Even when the analysis corrected for these conditions, the women were still 2.5 times more likely to die following balloon angioplasty.

"This study is significant because we compared men and women having the same procedure, angioplasty, and for the same condition, heart attack. Most studies to date have observed that in general, women are more at risk of dying from heart attacks than men, but this is the first study to compare the risks of men and women who have had heart attacks and the same treatment," said Drs. Brown and Vakili.

A third study found that over a 2-year period there was no difference in death rates among men and women with heart disease who were at low risk for death, but when they looked at men and women with heart disease who were considered high- risk patients (i.e., they had more clogged arteries in the heart and other unfavorable characteristics), it was obvious that women in the high-risk group had a much higher risk of death compared with men also classified as high-risk. The possibility of death was greater for high-risk women no matter how they were treated-with drugs, bypass surgery, or balloon angioplasty.

These results are in agreement with the first two studies discussed herein-both of which included women that were older and sicker than their male counterparts and both of which showed that the women fared worse than the men. The study was conducted by Dr. Michael Curtis, University of Alberta, Edmonton, Canada. A study by Israeli researchers suggests that mammography screening can not only be used to find early breast cancer but can also can identify women more likely to develop and die of heart disease by detecting small areas of calcification (hardening) in blood vessels in the breast. The Israeli researchers performed mammograms in 865 women being screened for breast cancer and looked for the presence of calcifications in the blood vessels in the breast. They found that women with calcifications were more likely to have conditions associated with heart disease, such as high blood pressure, diabetes, and high cholesterol. Women whose mammograms showed breast calcifications were twice as likely to have heart disease. The author concluded that mammograms can be used to screen women for breast calcification and identify women more likely to develop heart disease. This is a simple, effective, and inexpensive method to detect risk of heart disease, explained Dr. Eugene Crystal of Ben Gurion University in Beer Sheva, Israel.