Women with diabetes at higher risk for CVD, but they receive inadequate care.

2004 JUN 3 - (NewsRx.com & NewsRx.net) -- Women with diabetes are at greater risk for cardiovascular disease (CVD) than men with diabetes and persons without diabetes, yet prevention and treatment of CVD in women with diabetes is inadequate, according to an international group of researchers.

The risk of heart attack is 150% greater in women with diabetes than in women without diabetes, but only 50% greater in men with diabetes versus men without the disease. Women with diabetes are also more likely to have hypertension than are men with the disease. Most women with diabetes will develop CVD years earlier than women without diabetes. Between the ages of 65 and 79 years, women with diabetes show a two-fold greater risk of significant functional disability than do women without diabetes, and CVD is a significant contributor to this functional disability.

"Despite these numbers, physicians, researchers, and public health officials are not doing enough to adequately prevent and treat CVD in women with diabetes," says Elsa-Grace Giardina, MD, director of the Center for Women's Health at New York-Presbyterian Hospital/Columbia and professor of clinical medicine at Columbia University College of Physicians & Surgeons.

In an article published in the May 10, 2004, Archives of Internal Medicine, Giardina and co-authors cited one study in which 26% of women were misdiagnosed as having some condition other than CVD, compared with 18% of men. Specifically, and compared with men, heart attacks in women are more commonly undiagnosed, leading to delayed medical attention, less aggressive treatment, and, ultimately, complications, disability, and premature death.

The researchers argued that women, with or without diabetes, get inadequate treatment due to the lack of knowledge of how symptoms of CVD can differ between women and men. Women are also more likely to have jaw or neck and shoulder pain, nausea, vomiting, fatigue, or labored breathing, in addition to the more traditional chest pain during a heart attack. Sudden death from heart attack, especially silent heart attack, is also more common among women, and women more often delay seeking medical attention.

Compounding the problem, even if physicians request testing for CVD, are that the sensitivity and specificity of standard diagnostic techniques such as graded exercise tolerance tests and stress imaging studies are poorer for women than for men.

Women with diabetes also manifest high cholesterol differently, with greater decreases in HDL-C and apolipoprotein A-I levels and LDL size, as well as greater increases in ...