Women receive a raw deal in healthcare, especially when it comes to the treatment of heart disease. The discrepancies in the care of cardiac disease between female and male patients claim the lives of many women, who should receive better treatment sooner.
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Cape Town cardio thoracic surgeon Dr Susan Vosloo cited numerous studies and statistics to prove that women don't receive the quality of heart care that is usually reserved for men.
She addressed guests at the launch of Africa’s first Full Field Digital Mammography (FFDM). This new facility will improve early detection and diagnosis of breast cancer in women, and will go a long way to improve women’s health.
"Why are so many patients, particularly women, dying with symptoms of ‘indigestion’ or ‘depression’ or other vague background complaints?" Vosloo asked.
The fact that women have a raw deal where health issues are concerned, can be clearly illustrated in the discrepancies that exist in the cardiac disease care between female and male patients.
More women die of heart disease
In the USA, 8 million women have ischaemic heart disease (IHD). This is the leading cause of death in women in the US, with 50 000 more women than men dying annually of heart attacks.
Of the 30 people that die daily of heart attacks in South Africa, 10 are women.
Interestingly, a survey done in the US showed that only one in every three General Practitioners was aware of these facts.
Heart deaths decrease in men, but not in women
Worldwide, there have been a reduction in the number of deaths owing to IHD in males since 1984, but not in women. Why?
Women with myocardial infarcts (heart attacks) have a higher risk of dying, or of having a second heart attack, with overall 38% of women, and 25% of men, dying within one year of their first heart attack. Why?
There are now several documented studies that show how women receive less optimal cardiac care than men.
Although it is now well known that women benefit as much as men from preventative treatments like aspirin, beta blockers and cholesterol-lowering drugs, these are still grossly under-utilised in women, according to a study, published in the Annals of Internal Medicine in January 2003.
Emergency medical care for chest pain is also inferior for women.
Studies from Emory and Cincinnati University Schools of Medicine showed that:
women took longer to arrive at emergency units after developing chest pain compared to men.
women, presenting to the emergency room with chest pain, are less likely than males to have an ECG.
it took longer for women than men before receiving anti-coagulation/blood-thinning therapy.
women are also less likely to have cardiac catheterisation. A study of more than 100 000 patients after heart attacks in the USA, showed that 36,7% of women and 48,3% of men underwent cardiac catheterisation to identify coronary artery anatomy. This subsequent delayed treatment increased their risk of death at 30 days after a heart attack.
despite the fact that more women than men die annually of heart disease in the USA, it was shown that women received a lesser proportion of most treatment modalities, with female patients receiving only 33% of all PTCA or stent procedures; 28% of all implantable defibrillators; and 36% of all coronary bypass operations.
furthermore, women comprised only 25% of participants in all heart-related clinical research studies.
women, especially those younger than 60, have been shown to be more likely to die after interventions and the mortality for angioplasty and stent implantation or coronary bypass operations in women was 2,3 to 3 times higher in than men.
Who is at risk?
Women who smoke risk having a heart attack 19 years earlier than non-smoking women.
Women with diabetes are two to three times more likely to have heart attacks.
High blood pressure is more common in women taking oral contraceptives, especially if they are overweight.
Many women are sedentary and get no leisure-time physical activity.
23% - 38% of US women are obese and nearly 40% of South African women are overweight or obese, with variations existing for different population groups.
"These are facts that we should acknowledge, especially with the high incidence of heart disease in South Africa, so that we can identify such problems before we have to deal with their consequences," Vosloo said.
"It is clear that increased awareness and education, even of the medical profession, is required in this regard, as early detection of heart disease risk holds the key to improved outcome in women."
What about HRT?
Studies have shown that post-menopausal hormone replacement therapy may not have the beneficial cardiac protective effects as we all have believed in the past, and may even increase cardiac risk.
Clinical trials, like the Women's Health Initiative (WHI) and the Heart and Estrogen/Progestin Replacement Study (HERS), have provided women with a lot of information in a relatively short period of time.
At their 13th annual meeting of NAMS held in Chicago in 2003, Dr Wulf Utian (Emeritus professor at Case Western Reserve School of Medicine in Cleveland and executive director of the North American Menopause Society), emphasised that clear guidelines were required as these studies were ‘confusing enough’ for doctors, and led to widespread controversy. It's certainly most confusing for us as female post-menopausal patients with cardiac risk.
Some specific recommendations:
Symptom relief should be the primary reason for taking hormone replacement therapy
Hormone therapy should not be used to prevent heart disease; and women should take other measures to reduce that risk.
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