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Heart Disease in Women: A New Paradigm for Prevention & Treatment

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As women actresses walked the red carpet at the Golden Globe awards dressed in black in order to lend their support to the #metoo movement, I was touched by the notion that women are increasingly standing up for each other and coming together for the betterment of all women’s lives. As this consolidation of purpose is occurring, I can’t help thinking that we can do even more.

Shouldn’t there be a movement as powerful and significant as #metoo that could shed light on the fact that more women continue to die from heart disease than from any other cause? And—that this is largely preventable???

I have been involved with the Go Red for Women movement, an initiative created by the American Heart Association, that has been educating and empowering women to take care of their hearts and their heart health for over a decade. Yet, after all this time, I still become infuriated every time I see the statistics that women are still under-diagnosed, still provided with less life-saving treatment, and still referred less often for procedures that might actually result in more successful outcomes for them.

The bias—to treat women heart patients like men heart patients—still exists and has resulted in the deeply disturbing reality that when women get heart disease, they are more likely to die or to do much more poorly afterwards, including being more likely to suffer a subsequent heart attack.

#Metoo has sparked a lot of important, if difficult, feelings for all of us, both women and men. Many are finally coming to more fully understand the collective reality of women’s lives. This is a very good thing, because if we viscerally understand #metoo, then maybe we have a chance to understand #GoRed in a similarly urgent way.

The bottom line across the board is that women are paying a deep price just for being women, whether that involves being the victim of sexual assault or misconduct…or being the victim of an antiquated healthcare system that does not see and understand how heart disease manifests in and kills women.

Just to give you an example, which sheds light of how pressing this issue is for all women, a study was done simulating male and female patients going into the emergency room. The actors recited the same script about their symptoms to the ER doctors. What happened? The male actors were admitted to the hospital with the diagnosis of possible heart attack; the women actors were sent home with the diagnosis of “anxiety.” Really? With the same script and the identical symptoms, this is still happening? We are victims of stereotypes, misconceptions, callousness or, worse, disregard.

The good news is that the research is finally catching up to the reality. In the last decade, we have made significant progress in the study of women and heart disease. The Guidelines for the Prevention of Cardiovascular Disease in Women, last updated in 2011 by the American Heart Association, showed the profound impact of hypertension, diabetes and depression on women’s hearts and explained that pregnancy can be a sort of “metabolic stress test” because there are many warning signs of future heart disease in pregnant women. That is progress.

There are also the Guidelines for the Prevention of Stroke in Women, issued jointly by the American Heart Association and the American Stroke Association in 2014, showing that pregnancy, hormones and migraines all contribute to the risk of stroke. Furthermore, the American Heart Association’s Scientific Statement from 2016 about Acute Myocardial Infarction in Women sheds light on how women who have had a heart attack are less-frequently referred to life-saving treatment and are less likely to be prescribed medication to prevent complications, improve quality of life and to prevent a second heart attack. (Note that “myocardial infarction” is the medical term for heart attack.)

This is all significant—then again, the change isn’t happening fast enough. We are still seeing more women dying of heart disease, and heart disease still causes more deaths in women than all cancers combined.

I propose a new paradigm, not just in cardiology but across the board at all levels of women’s health care, from OB-GYN to general practitioners. I propose that we focus on the preventive aspects of heart health and provide active and effective strategies for early detection of disease in every at-risk woman before there are clinical manifestations. And by every at-risk woman, I mean every woman.

I believe that in order to change these statistics, we have to change the culture, which, as we all know, is a slow process. In the meantime, women (and I include myself of course) need to take charge of their hearts and understand the critical nature of being their own advocates and fighting for the help they need to implement the preventive strategies that we already know. These include:

  • Understanding the huge impact of psychosocial risk factors on women’s hearts, and addressing problems like depression and social isolation.
  • More aggressive screening in women with any family history of heart disease, but especially for those with multiple risk factors.
  • Taking seriously any hypertension or diabetes during pregnancy, since heart disease in women typically begins with endothelial dysfunction, which can be detected in pregnancy. (Endothelial cells line the heart and blood vessels.)
  • Regularly ordering screening tests that look for plaque in the arteries, such as coronary artery calcium scores or carotid dopplers, as part of annual health exams in women over 40. The goal must be to find disease before it starts.

I believe we can beat the number-one killer of all women if doctors decide to make a real commitment to diagnosing earlier in the disease process, and if women decide to implement lifestyle changes and, if necessary, medications to prevent progression. This goal is multi-fold and necessitates the participation of women patients, doctors, and the medical system in general. But that is the nature of real change. We all need to collaborate on this significant venture.

As women’s needs are increasingly coming to the forefront of the cultural mindset, let’s take advantage of this momentum to use the tools we have to become less reactive within the framework of the current paradigm of women’s health care, and more proactive in caring for women’s hearts in ways that are effective. It’s time to set aside opinions, old ways, and traditional methods in favor of the current data, because so far, our opinions have been selling women short.

It is (literally!) heartbreaking that this is the current state of medicine. so let’s change that. I think it has become clear that the time is now.

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