Cardiovascular Disease in Women

By Nick van Terheyden aka Dr Nick, Principal, ECG Management Consulting
Twitter: @drnic1
Host of Healthcare Upside Down#HCupsidedown

Looking back at my medical training, there are more than a few instances where I wonder how we accepted the status quo without questioning more and pushing back. Heart disease was one of those areas that, in hindsight, was seen through a very gender-biased lens.

Although heart disease has long been the number one killer of men and women, it was traditionally long thought of as a man’s disease. We saw and treated heart disease in women, but our misunderstanding of its different presentations in women resulted in underdiagnosis and undertreatment. Gender differences in heart disease remained unexplored as women were underrepresented in, or worse, excluded from clinical trials and research, and there were no guidelines to inform clinical decision-making.

Things have improved in the past few decades, with gender-specific clinical recommendations for heart disease in women. Our understanding of gender differences and the need for more personalized approach continues to evolve, but we still have some way to go.

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On this episode our guest is Rupa Sanghani, MD, a professor of medicine at Rush Medical College and the associate director of the Rush Heart Center for Women. She discusses cardiovascular risk factors in women, the need for medical professionals to recognize the different ways women present with coronary disease, and what she tells patients about the effect of pregnancy on the heart. Below are a few excerpts.

A new understanding of an old problem.

“Heart disease is the leading cause of death in women in the United States, and one in three women have some form of cardiovascular disease. [Historically], women were treated essentially the same as men, because we assumed the disease process was the same. If you look at cardiac mortality trends in the US in the past, we did a great job in the late 1990s, with both men and women, but women clearly lagged behind men. And part of it was that we didn’t appreciate the sex differences, and we weren’t enrolling women in trials and actually looking at how the disease was different. Unfortunately, mortality trends are going back up for both genders again. So we still have a lot to learn.”

Misconceptions about heart disease in women.

“[There are] misconceptions that younger women who come in with chest pain [don’t have] coronary disease. It absolutely can be. But for women over the age of 50, 55, our risk is the same as, if not greater than, that of men. How they present, though—the textbook definition of chest pain does occur in women, but more often, it is vague symptoms. It can be shortness of breath, it can be fatigue, it may be more of a sharp chest pain. What I [ask] my patients is, does something feel different? Are you not able to do what you normally do? I think functional ability and keeping up with what they’re normally able to do is a big factor, but it’s also just being aware of who is at risk.”

Cardiovascular risk factors and pregnancy.

“I like to think of pregnancy as a nine-month-long stress test. Your blood volume or plasma volume almost doubles. It is a huge volume load on the heart, so it often can unmask underlying heart problems, not just coronary disease. With any hypertensive disorder of pregnancy, you are at higher risk of developing hypertension, often within 10 years of delivery. A woman who has any hypertensive disorder or diabetes during pregnancy needs to know they’re at risk for this and get good follow-up. Now, of course, these are the women that have just had a baby. And those first 10 years, they’re crazy busy and aren’t coming in as regularly because they’re in their 20s, 30s, or early 40s, and not really thinking about themselves and not thinking that they’re at risk. And so for all of us, it’s a call to action to recognize that this is a real risk factor.”

This article was originally published on the ECG Management Consulting blog and is republished here with permission.

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The US spends more on healthcare per capita than any other country on the planet. So why don’t we have superior outcomes? Why haven’t the principles of capitalism prevailed? And why do American consumers have so much trouble accessing and paying for healthcare? Dive into these and other issues on Healthcare Upside/Down with ECG principal Dr. Nick van Terheyden and guest panelists as they discuss the upsides and downsides of healthcare in the US, and how to make the system work for everyone.

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