Update on Women and Their Hearts: No Longer Second-Class Citizens

When I began my cardiology practice, oh so many years ago, my training led me to believe that most heart attacks occurred in men.  Many of my heart-specialist colleagues were less aggressive in their evaluation and management of women who were often treated as second-class citizens when it came to heart problems.

The belief that heart disease is a “man’s disease” has been debunked, and there has been an increasing awareness that coronary heart disease (CHD) accounts for almost half of all deaths among women in the U.S.  In 2007, heart disease in women caused approximately one death a minute, more than 400,000 in total, which represented more lives than claimed by cancer, Alzheimer’s disease, pneumonia and accidents combined.

Earlier this year, the most recent American Heart Association guidelines for the prevention of heart disease in women were outlined in the Journal of the American College of Cardiology.

In the past, almost all clinical trials excluded women. Now that they have been included and given the awareness of the importance of lifestyle changes — smoking cessation, heart-healthy dieting, regular exercise and weight management — there has been significant drop in CHD deaths in women over 55. Yet, unfortunately, in women 35 to 54, death rates appear to be increasing, likely as a result of  the obesity epidemic.

The new guidelines were based on effectiveness observed during clinical practice, weighing benefit and risk.  In addition to lifestyle changes in behavior, the evidence showed that careful control of blood pressure, elevated cholesterols and diabetes brought about absolute prevention.

In contrast, certain controversial interventions have been shown to be not useful and ineffective.  These include:  hormone replacement therapy,  antioxidant supplements (vitamins E, C and beta carotene), folic acid supplements, and daily aspirin in women less than 65.

In my practice, one of my biggest challenges has been to succeed in bringing about lifestyle changes. This is especially true with women because their caretaking responsibilities often result in stress, sleep deprivation and lack of personal time.

These are realistic issues. But it is because of these life-long responsibilities that infuse women’s lives that it is all the more important for them to put themselves first when it comes to their own healthcare.



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