Women Still Treated Less for Heart Disease

Studies Show Many Doctors Order Far Fewer Tests, Preventive Measures Than for Men

Women remain far less likely than men to get basic medical care that could significantly reduce their risk of heart attacks and strokes, leaving thousands unnecessarily vulnerable to the nation's leading cause of death, researchers reported yesterday.

Despite clear evidence that women are as prone to heart attacks as men, a spate of new studies shows that many doctors fail to treat them as aggressively, ordering far fewer tests and taking far fewer preventive measures, such as prescribing aspirin, diet and exercise regimens, and drugs to lower cholesterol and blood pressure.

Numerous previous studies have shown that women are not treated as intensively for cardiovascular disease as men and are much less likely to survive a heart attack or stroke, and the new studies show little has changed despite years of efforts to educate women and their doctors.

In response, leading heart specialists issued yet another appeal to doctors and patients to make sure women get adequate care, including the latest tests that can detect heart disease in its earliest, most treatable, stages and treatments that have proved effective for both sexes.

"Heart disease is the number one killer of women," said Robert H. Eckel, president-elect of the American Heart Association. "Women have more heart disease than men, yet effective diagnosis and management is still inadequate."

Cardiovascular disease is the leading cause of death for both men and women but kills more women overall -- nearly 500,000 each year, more than the next seven causes of death combined and nearly twice as many as all forms of cancer.

"There's no question that we could be preventing many more heart attacks and deaths in women," said Rose Marie Robertson, the heart association's chief science officer. "We want women to be aware of this problem and to realize that there are many ways we can effectively prevent heart attacks and strokes."

In one of the new studies, Lori Mosca of Columbia University in New York and her colleagues asked 500 doctors from around the country to evaluate the records of male and female patients and make recommendations for treatment.

Even when a woman's risk was the same as a man's, the doctors were about 40 percent less likely to classify them as being at high risk, the researchers reported in the Feb. 1 issue of the journal Circulation, published by the heart association. As a result, the doctors were much less likely to recommend that women receive the basic kinds of treatments that have been shown to significantly reduce the risk of heart attacks and strokes.

"We've known for some time that women are not getting the same level of treatment in terms of preventive care, compared to men, and we didn't fully understand why," Mosca said. "What's really striking is that we could explain the differences in preventive treatment between men and women by the fact that physicians were more likely to underestimate risk in woman compared to men."

Fewer than one in five doctors knew that more women die of heart disease than men each year, the researchers found.

"This is a huge finding, because what it tells us is that if we can teach doctors to calculate risk rather the use the eyeball test, we can reduce the disparities in care between men and women, which should lead to a reduction in heart attacks in women," Mosca said.

In a second study, Mosca and her colleagues studied a 1.1 million-patient database from a managed care plan, identified 8,353 women who were at high risk of having a heart attack and followed them for three years to see how their cholesterol was treated.

Only about one-third of the women who should be taking cholesterol drugs were receiving them, the researchers found. In addition, at the beginning of the study, only 7 percent of the high-risk women had their cholesterol levels at desirable levels, and that improved to just 12 percent in the next three years.

"We clearly have a long way to go as far as optimizing the care of women in terms of cholesterol management, especially in the highest-risk women," Mosca said. "It's a problem for both genders, but it seems to be more of a problem for women than men."

Both studies were funded in full or in part by Kos Pharmaceuticals, of Cranbury, N.J., which makes drugs that lower LDL, the "bad cholesterol," and raise HDL, the "good cholesterol."

In the same issue of the journal, the association issued new policy statements recommending women receive the same kinds of tests and treatments that are commonly used on men, such as angioplasty to reopen blocked arteries.