Heart Disease Treatment for Women

» Request a referral to a John C. Lincoln cardiac specialist.

Women not only have a different set of heart disease risk factors, they also may experience a wider, gender-specific set of heart disease symptoms.

For this reason, heart disease treatment for women must take into account these gender-specific risks and symptoms.

John C. Lincoln Hospitals are striving to provide a higher standard of cardiac care for our female patients. In concert with current research and new medical approaches, we are tailoring diagnostic testing and medical treatments to the specific needs of women.

Equality Needed in Heart Disease Treatment for Women

Unfortunately, historically speaking, female patients have been significantly less likely to receive the same heart-disease therapies as men — namely medications, coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI).

A recent statistical review of data from nearly 200,000 patients indicates that women are less frequently given aspirin, glycoprotein IIb/IIIa inhibitors (which prevent blood platelets from binding together) and cholesterol-lowering statins when hospitalized. Further, in analysis of data on more than 2.5 million patients between 1990 and 2006 has demonstrated that, upon discharge, women are not prescribed aspirin and cholesterol-lowering medications as frequently as men.

The trend holds true for procedures, as well. Performed more than 500,000 times each year in the U.S., coronary artery bypass graft (CABG, pronounced "cabbage") surgery is one of the nation's most common. However, fewer than one-third of these procedures are performed in women. What's more, just one-third of all percutaneous coronary interventions (PCI) in the U.S. are performed in women.

The benefits of CABG and PCI are widely established. Evidence-based guidelines show that women and men should receive the same treatments. The long-term survival between men and women is the same. However, a common misconception exists among cardiologists that CABG and PCI in female patients are less successful and associated with a higher complication rate.

Why is this so? It's true that women are diagnosed with heart disease, on average, approximately 10 years later than men. After menopause, the protective benefits that estrogen has on the heart disappear, opening the door for heart disease.

Because they are older when they seek treatment, women are more likely to exhibit co-morbidities — additional underlying medical problems, such as diabetes and hypertension — and can be in greater need for urgent or emergency surgery. Therefore, gender, alone, should not be viewed as a risk factor for post-procedure mortality.

Tailoring Heart Disease Treatment for Women

For female patients with advanced heart disease, one emerging treatment alternative to CABG is OPCAB, or "off-pump" coronary artery bypass. In CABG, the heart is stopped, and the patient is placed on a heart-lung machine. By contrast, OPCAB is performed while the heart continues beating. Complication rates for women are typically lower in OPCAB procedures.

Women are also more prone to bleeding complications compared to their male counterparts. One cause is blood thinners, which tend to cause more bleeding in women than men. This is frequently the case because the same doses are given for men and for women. Being smaller, women may not be able to tolerate the same dose; adjustments to doses, compensating for height and weight, may be necessary.

Combinations of Diagnostic Tests Sometimes Required

Purely physical differences between men and women can complicate diagnosis of heart disease in women. In several critical ways, deposits of artery-clogging plaque (comprised of cholesterol and fats) can form in the arteries differently in women.

For men, plaque forms along artery walls in clumps. For women, plaque is more likely to be distributed evenly throughout artery walls and in the smaller blood vessels of the chest — the so-called "microvasculature." These microscopic blood vessels, which branch out like the smallest twigs on the end of a tree limb, can be very difficult to see in a traditional angiogram, requiring other diagnostic testing approaches.

For women, plaque is more likely to change the shape of an artery, by ballooning, or bulging, off to one side. As a result, blood is able to flow as it normally, giving a misleading picture of a plaque deposit's size.

Some of the tests developed for identifying heart disease are less accurate when performed on women than men. Therefore, some patients may require a combination of diagnostic heart tests and heart imaging techniques before our physicians can determine whether heart disease is present.

» Request a referral to a John C. Lincoln cardiac specialist.