Cardiovascular disease in women

In the 1980s, women’s health, especially heart health did not account for much research. Despite having heart disease develop later in life than in men, women faced severe prognosis after surgery.

Institutions such as the National Institutes of Health (NIH) lacked policies on including women in clinical trials. Significant trials women were approved by the NIH. For example, the Physician's Health Study (1981) studied the effects of aspirin, particularly to reduce the prevalence of Myocardial Infarction. However, due to the lack of research, its effects in women were unaccounted for.

Food and Drug Administration (FDA) policy prohibited women in both childbearing years and those outside these ages, from inclusion in advanced drug trials. This was done to address concerns of birth defects among infants and changes in estrogen and progesterone in postmenopausal women. Between 1988 and 1991, only 50% of the analysis done on data from trials not designed for women, accounted for the difference in gender. It was assumed that the drugs given to men would work if prescribed to women.[4]

Studies such as the Western Collaborative Group Study (report issued 1975), the Los Angeles Heart Study (published 1964), and the Pooling Project 5 (report issued 1978) included a small population of women in their research, but published reports and data of only white males. The Pooling Project 5 consisted of three studies with only males and two with females. These studies showed signs of the high risks women face with CAD, but no progress in terms of the treatment course.

The Tecumseh and Framingham studies along with the Rochester Coronary Heart Disease Project were longitudinal studies that included women and provided notable results. In the 1960s, it was reported that hypertension, high cholesterol, and obesity were key risk factors of CAD in women. Reports from the Coronary Artery Surgery Study suggested that chest pain was not an effective indicator of Congenital Heart Disease (CHD) for women.[4]

Awareness of CVD and related heart diseases among women increased from 1997 to 2000. According to a survey conducted by AHA in 2000,[5] women are now more aware of the leading cause of death for the gender, than they were in 1997. Close to 90% of women are now aware that women experience heart disease symptoms gradually in later years and that the initial hours of treatment are critical to reduce damage to the brain and heart. They are also aware of the possibility of resultant strokes.

However, due to infrequent exposure to the concerns and a deficit of personalization, CVD awareness still lacks among women, especially in the most favorable age groups of 25 to 34 years. Nearly 72% of women in this age group consider cancer to be the leading cause of death, however, with an increase in age, the understanding of heart diseases has also shown to increase. Women from different ethnicities have also become more aware of their health and related issues. In the 1980s, African American women had double the mortality rates compared to other women between the ages 30 to 39.[4] More recently, about 42% of black women are now more aware through discussions with their doctors of the risks of heart disease or stroke, compared to 34% white women and 32% Hispanic women.

A national survey conducted by AHA in 2012, suggested increased rates of awareness and consciousness. According to the fifteen-year trend report, some of the significant changes are as follows:[6]

• In 2012 the level of awareness increased in women from different ethnicities with percentages rising up to 65% white, 36% black, and 34% Hispanic.
• In terms of knowledge of the symptoms of heart attack, 18% of women responded with nausea, while 56% responded with chest pain.
• In case of experiencing a heart attack, 10% of Hispanic women were reported to initially take aspirin, compared to 22% black and 18% white women.
• The top 3 health management issues were reported to be exercise (by 49% of women), weight (by 47%), and cholesterol (by 45%).

Analysis of data suggests further improvement in the educational efforts and awareness among women, especially of racial and ethnic minorities, as they face higher mortality rates.

In 2014, provisions created under the Affordable Care Act (ACA) enabled 4.3 million women to have medical coverage by law and close to 48.5 million women to have access and benefits of preventive care, with companies charging women the same premiums as men. The Act also requires for Medicare and private health plans to provide preventive care coverage.[3]

CVD is the leading cause of death in American women, as opposed to what was thought, i.e. cancer. Over the years, while death rates have decreased in men, women continue to misidentify the underlying causes. Gender plays a role in the atypical symptoms experienced by the individual. Women do not experience the same symptoms as men (for example sharp shooting pains along the left arm). Symptoms of CVD (including heart disease and stroke) in women include:[7]

1. Pain in chest, shoulders, neck and arms
2. Shortness of breath
3. Nausea and Dizziness
4. Headaches and fatigue
5. Sudden and random sweating
6. Palpitations and faster heartbeats
7. Numbness and extreme weakness
8. Sudden loss of vision[5]

Some common symptoms of Angina (inaccurately assumed to be heartburn or indigestion) include tightness, pressure, burning.

1. Go Red for Women
2. FDA Regulations, Guidance, and Reports related to Women’s Health
3. Coronary heart disease in Western Collaborative Group Study. Final follow-up experience of 8 1/2 years
4. Sex/Gender Differences in Cardiovascular Disease Prevention What a Difference a Decade Makes
5. Women & Cardiovascular Diseases