"What has terrified women for years is breast and other cancers, so women have adequate awareness and acceptance of screening for cancer." Dr. Keller explained, "Although cancer is important, it is hard to get them thinking about screening beyond that. It is not just the lay public we need to reach about this problem--it is the medical community as well." Dr. Keller spoke today at an American Medical Association media briefing on cardiology in New York City.
Health care for women has long focused on screening for breast, ovarian, cervical and other cancers, yet what many people do not know is that the number one killer of women over the age of 45 in the United States is heart disease. The statistics are not new--heart disease has been the number one killer of women for 100 years. It kills 65,000 more women than men, taking the lives of younger women (under 45) as well as older women at alarming rates.
"We thought hormones have a protective effect on women's hearts, but it turns out they do not," Dr. Keller said. "The hormone replacement therapy data has been really disappointing." Increasing obesity rates in both U.S. men and women are adding to the problem, and many women have plaque buildup, an early sign of cardiovascular disease, at an early age.
Screening for heart disease, Dr. Keller explained, involves identifying potential risk factors such as smoking, obesity, high cholesterol, diabetes, high blood pressure and family history of heart disease, and then performing stress test and coronary angiogram when appropriate to assess the condition of the heart. Women, however, are often not screened adequately and for many, their first cardiac event could wind up causing heart damage or death. "Women are referred for testing much less often than men are," Dr. Keller said. "Their risk factors are not addressed as aggressively. Cardiac disease has always been thought of as a male disease, even in the medical community. Most of the research has been in men with the results extrapolated to women."
Many women with heart disease have no symptoms and many of those who die of it could have been saved with medication or angioplasty/surgery if the disease was caught at an earlier stage. "If you look at most of the women who die of heart disease, an identifiable risk factor could have been addressed," Dr. Keller said.
Even women who are identified and treated have poorer outcomes than their male counterparts, Dr. Keller said. "The initial misdiagnosis and lack of referral take their toll. In addition, women who have heart attacks are less likely to be referred to cardiac rehabilitation programs and are less frequently placed on medication than men who have heart attacks."
The best bet for women in avoiding heart disease is to control their risk factors by leading a healthy lifestyle--watching their weight and diet, exercising and most importantly not smoking, Dr. Keller advised. She added that being proactive with the primary care physician is a must. "Even if you are having no problems, ask your doctor once a year--what is my blood pressure? My cholesterol (the good and the bad), sugar? Know your numbers."
Media Advisory: To contact Norma Keller, M.D., call Kenneth McMillan at 212/404-3694 or email: kenneth.mcmillan @med.nyu.edu. On the day of the briefing, call the AMA's Science News Department at 312/464-2410.