UCSF Study Finds Men And Women Express Similar Willingness To Undergo Invasive Cardiac Procedures

Women are as likely as men to agree to a doctor's recommendation for an invasive cardiac procedure after testing positive for heart disease, according to a new study conducted by University of California San Francisco researchers. Results of the study are published in the February 9 issue of the Journal of General Internal Medicine.

According to the American Heart Association, each year about half a million American women die of heart disease, strokes and related disorders--more than twice the number who die from all cancers combined. More women than men die from cardiovascular diseases, and women are more likely than men to die after a first heart attack.

Despite these facts, studies have suggested that women with known or suspected heart disease receive less aggressive treatment than men because women refuse invasive treatment for the disease, researchers said.

"Our study suggests that this explanation for gender differences in the use of invasive cardiac procedures is incorrect," said Rita Redberg, MD, MSC, UCSF associate clinical professor of medicine and anesthesia, co-director of the UCSF National Center of Excellence in Women's Health and co-author of the study. "One reason for gender disparity is that, traditionally, women are referred at lower rates by physicians for invasive procedures after a positive stress test."

She added that there is a lack of awareness about heart disease--the number one killer of women--in both the lay and medical communities. For instance, women are generally more concerned about developing cancer, particularly breast cancer, although this disease results in far fewer deaths than those caused by heart disease.

To explore the role of patient preference in explaining gender disparities in the use of invasive cardiac procedures, researchers surveyed 174 UCSF patients who underwent a non-invasive stress or exercise test, an indicator of heart problems.

Taking into account sociodemographic factors, health status, symptom severity, and history of prior procedures, women expressed a greater willingness than men to accept a physician's recommendation of an invasive cardiac catheterization. In addition, men and women reported a similar willingness to accept a recommendation for coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG).

Study participants (69 of whom were women, and 105 men) completed a self-administered questionnaire that included items addressing demographics, health status, symptom severity, coronary risk factors, and history of prior invasive cardiac procedures.

Compared with men in the study (mean age 59.4 years) women (mean age 60.2 years) had a lower income and fewer years of formal education, were less frequently employed, and were less likely to be married or living with a partner. In addition, women also had worse self-perceived health status and cardiac symptoms, more diabetes, and fewer prior heart surgeries, including a CABG.

The implications of the study are that physicians need to be more conscientious about offering men and women the same options for treatment of cardiac disease, Redberg said. In addition, for more severe forms of heart disease, invasive treatment may be more beneficial than conservative therapies.

The good news, she added, is that awareness of heart disease among women and the medical community is growing and is particularly important because it is a preventable disease.

Exercising, not smoking, eating a low saturated fat diet, having your blood pressure checked regularly, and speaking to your physician about hormone replacement therapy (for post-menopausal women) are mechanisms for preventing heart disease.

Other researchers of the study include University of Washington associate clinical professors of medicine (formerly faculty of UCSF at the time of the study), Somnath Saha, MD, MPH, and Glen D. Stettin, MD.

NOTE:
Redberg will be discussing women and heart disease during a talk called "What You Can Do To Change the Statistic: Women Should Not Be Dying of Heart Disease" at UCSF's upcoming Women's Health 2000 symposium. The event will take place on Saturday, March 20 at UCSF's main campus, 513 Parnassus, from 8:30 am-4:30 pm. More than twenty-five topics requested by women in the Bay Area will be discussed by UCSF women's health experts including women's sexual health, herbal remedies and dietary supplements, menopause and being a successful patient in managed care.

Teen Health 2000--designed exclusively for young women ages 13-18--also will be held at UCSF and runs concurrently with Women's Health 2000. Including lunch and live entertainment, price is $40 for adults, $30 for seniors and $10 for teens. To register or for more information, call 415-263-0321.