Heart Disease Gender Gap Narrows

MONDAY Oct. 26, 2009 -- Hearts attacks have increased among middle-aged American women in the past two decades, but their chance of survival has improved, two new studies show.

"We found that men still have a higher prevalence than women, but what has happened is that the gap has narrowed," said Dr. Amytis Towfighi, assistant professor of clinical neurology at the University of Southern California, lead author of one of two reports in the Oct. 26 issue of Archives of Internal Medicine. "For women it has increased, for men it has decreased."

Her study used data from two national surveys conducted from 1988 to 1994 and 1999 to 2004. While 2.5 percent of the men and 0.7 percent of the women reported a history of heart attacks in the earlier survey, 2.2 percent of men and 1 percent of women reported heart attacks in the more recent survey.

The narrowing of the male-female difference is easily explained, Towfighi stated. "Very basically, the risk factors are being better controlled in men than in women."

In men, levels of "bad" LDL cholesterol remained the same between the two surveys, while levels of "good" HDL cholesterol improved. Blood pressure levels improved, and fewer men smoked.

The improvements for women were marginal, with LDL cholesterol levels about the same. The only risk factor that improved in women was HDL cholesterol. Diabetes and obesity increased in men and women, the study found.

"We don't know exactly what is going on in terms of risk factors being better controlled. Women aren't checked as often," Towfighi acknowledged.

Societal changes may play a role, she said.

With more women in the work force, she said, their rising rates of obesity and diabetes can be attributed to job demands that limit their ability to exercise and follow dietary rules.

It is no longer assumed that female hormones protect against heart disease, she said. Doctors are paying more attention to heart risk factors in women because "there is a red flag about women not being absolutely protected against heart disease in midlife, as we had thought, and we are aware that more effort must be made to reduce their risk," Towfighi said.

The second study used information from a different data bank listing death rate trends from 1994 to 2006. It found a marked reduction in hospital deaths from heart attacks in all patients, especially among women. For women under 55, the risk of dying dropped by 53 percent, which was the greatest improvement noted. The least reduction, 33 percent, was seen in men under 55.

A detailed examination of cardiac risk factors showed that "women experienced less worsening than men," said Dr. Viola Vaccarino, professor of medicine and director of the Emory Program in Cardiovascular Outcomes Research and Epidemiology, lead author of the report.

But changing attitudes about women and heart disease may also have had an effect, she said.

"Perhaps physicians are paying more attention to the detection and treatment of women with heart disease," Vaccarino said. "It could be the same thing happening in the general public, with women getting more knowledgeable about this."

"Basically, both studies show that there still is a gap between men and women," said Dr. Nieca Goldberg, clinical associate professor of medicine at NYU Langone Medical Center and a spokeswoman for the American Heart Association. "They both show the importance of continuing to pay attention to women's risk of cardiovascular disease and treatment of their heart attacks."

The studies offer some good news for women, Goldberg said. "I'd like to think that's because we have increased the awareness of women themselves. But these two important studies show the need to continue research about reducing women's risk of cardiovascular disease."

More information

To find out who is at risk for coronary artery disease, visit the U.S. National Heart, Lung, and Blood Institute.

Posted: October 2009


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