... very few women. Our knowledge of heart disease in wome

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Women and Coronary Artery Disease (CAD)

• Module 1 Introduction

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Supported by an unrestricted educational grant
from Fujisawa Healthcare, Inc.
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Historical Perceptions in the Medical Profession

• Misperceptions
• Heart disease is a mans disease
• Womens chest pain symptoms are not due to heart
  disease
• Enrollment of women in clinical trials
• Research studies (up until recently) included
  very few women
• Our knowledge of heart disease in women has been
  rather poor
• Gender bias in diagnosis and treatment
• Undertreatment and underdiagnosis of women
• Less aggressive care ? higher complications and
  death rates

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Myths vs Facts
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Womens Perceptions of Heart Disease

• 72 of young women (ages 25-40) still consider
  cancer to be the greatest threat to womens
  health
• Some women know about the risks of heart disease
  but do not hear it from their own doctors and do
  not personalize it
• 65 of women recognize that symptoms may be
  atypical but do not know classic symptoms
• Most women learn about coronary artery disease
  (CAD) from magazines and the Webnot from their
  own physicians!

Robinson A. Circulation. 2001
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Gender Bias in the Treatment of Women

• The community has viewed womens health almost
  with a bikini approach, looking essentially at
  the breast and reproductive system, and almost
  ignoring the rest of the woman as part of womens
  health . Nanette Wenger, MD Chief of
  Cardiology, Grady Hospital Professor of
  Medicine, Emory University Atlanta, Georgia

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Magnitude of the Problem

• 2.5 million women per year in the US are
  hospitalized with cardiovascular disease (CVD)
• Deaths from CVD 500,000/yr
• Leading cause of death in US women CAD
• gt230,000 women die from CAD each year
• 1990 US Congress directed the National
  Institutes of Health that women be included in
  clinical trials and that gender differences be
  evaluated

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Women in Clinical Trials

• Women are underrepresented in cardiovascular (CV)
  trials
• Evidence-based CV medicine biased toward men
• Food and Drug Administration/National Institutes
  of Health mandate 50 enrollment of women
• Women need to be empowered to enroll in clinical
  trials for heart disease
• Breast-cancer awareness is a good example

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Publication Bias Gender Representation and
Negative Studies

• 1966-1994 noninvasive testing literature
• 8 to 27 women
• Lower diagnostic accuracy in women
• High false-positive rates
• Inability to perform maximal stress

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CVD Mortality Trends (1979-1999)
Deaths in Thousands
American Heart Association. 2002 Heart and Stroke
Statistical Update. 2001
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Prevalence of CVD in the US
American Heart Association. 2002 Heart and Stroke
Statistical Update. 2001
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Deaths From CVD and Cancer by Age and Sex
Anderson RN. National Vital Statistics Reports.
2002
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Myocardial Infarction (MI) Incidence (1979-1994)
Men
Women
Roger VL, et al. Ann Intern Med. 2002
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Deaths From CVD (1999)
American Heart Association. 2002 Heart and Stroke
Statistical Update. 2001
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Age-Adjusted Death Rates for Major CVD
J Am Coll Cardiol. 2000
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Health Threats to Women Perception vs Reality
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1. Gallup survey. 1995 2. American Heart
Association. Heart Stroke Facts. 1996
Statistical Supplement
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Death From Breast Cancer or Heart Disease in
Women in the US
US Vital Statistics, 1990
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Does CVD Affect Many People?

• 1 in 5 people has some form of CVD
• CVD claimed 1 million lives in 1999
• 40 of all US deaths
• 1.1 million heart attacks each year
• 7 million doctor visits each year for chest pain
• 600,000 strokes each year
• CVD accounts for 15 to 33 of all healthcare
  costs

American Heart Association. 2002 Heart and Stroke
Statistical Update. 2001
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Statistics for Women

• 503,927 died of CVD in 1998
• 226,467 from heart attack or other cardiac events
• 97,303 from stroke
• 1 in 5 women has some form of CVD
• 38 of women who have a heart attack die within
  1 year
• 40 of coronary events in women are fatal
• Most occur without prior warning

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Coronary Heart Disease Death Rates by State
(1996-1998)
American Heart Association. 2002 Heart and Stroke
Statistical Update. 2001
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Diagnosis and Management of CAD in Women

• Gender differences in presentation,
  manifestation, and diagnosis of CAD
• Gender differences in mortality
• 63 of women who die suddenly from CAD had no
  prior warning symptoms
• 42 of women vs. 24 of men will die within one
  year after MI
• Thus, early recognition of symptoms and accurate
  diagnosis of CAD is of great importance

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Does Gender Matter in CAD?

• 2001 Institute of Medicine report Exploring the
  biological contribution to human health does sex
  matter?
• Confirmed that significant differences between
  the sexes affect the prevalence, incidence, and
  severity of a broad range of diseases and
  conditions
• This is certainly true for CAD