Women and heart disease. (includes related information on heart attack, gender bias in research, and tests for coronary artery disease)

Although heart disease has been considered mainly a "man's disease" and heart attack rates in women lag behind those in men, after a certain age coronary artery disease affects both sexes equally. Moreover, when women do have a heart attack they are more likely than men to die of it. Curiously, however, there is no accurate model for heart disease in women. Until now most research was done in men -- women have been under-represented in heart studies, under-investigated, under-diagnosed and, some say, under-treated. They are insufficiently informed about their endangered heads or how to protect them.

Heart disease is a leading killer of women

When asked to name the chief killer of women, many will say "breast cancer." Yet, in fact cardiovascular disease is the leading cause of death among women: 41 per cent of deaths among Canadian women -- 37,000 a year -- occur from heart disease or stroke, seven times more than the number due to breast cancer.

One obvious difference between coronary artery disease (CAD) in men and women is the older age at which it strikes females. Heart disease usually appears in women about 10 years later than in men (although a significant proportion of heart attack deaths in women still occur before age 45). Until menopause, women's hearts are protected by the female hormone estrogen, but around age 50-55, as their estrogen levels drop, women start to catch up to men in CAD rates. By age 65-70, heart attack rates are similar in both sexes, with one in three affected by coronary disease.

Heart attacks are often more severe in women

Studies show that about one third of those suffering a heart attack -- of either sex -- die before reaching hospital. But when a woman has a heart attack her prognosis (outlook) tends to be worse than a man's, and she is more likely to die during a first attack. Also, more women than men suffer a second heart attack soon after the first and more women die within a year of their first heart attack. Women with diabetes are at special risk.

Gender differences in cardiac management

Despite the fact that after a certain age both sexes are equally prone to CAD, women with chest pain or other coronary symptoms tend to receive less urgent attention than men -- they are less likely to be investigated for heart disease and are less often referred to cardiologists. Not only do women receive fewer cardiac tests than men (reducing the likelihood of early diagnosis), but they are also less readily admitted to hospital and less likely to receive heart-saving treatment. Age and symptom-matched studies reveal that women are less often admitted to the hospital's intensive care unit (ICU) and less often receive thrombolytic (clot-dissolving) therapy or bypass surgery. Moreover, in the past when women did get revascularization -- treatment to restore the heart's bloodflow -- they often benefitted less than men. This could be because their disease was more advanced by the time they were investigated and treated and also because their smaller body size and smaller arteries were considered unsuitable for certain …