Behind a healthy, successful man is a supportive woman unaware of her own cardiovascular health risks
By Stephanie Martha O. Obillos, MD, (UP-PGH) and Jastin Manaloto, MD (SLMC – BGC)
Cardiovascular disease (CVD) has long been considered a male disease, that there was even a time that women were only encouraged to take care of, support and protect the heart health of the men in their lives.
But through the pioneering efforts of Professor Nanette Wenger, MD and her colleagues, the spotlight has now shifted to women’s cardiovascular health and how this multifaceted disease condition affects them independently.
In her lecture on women’s heart health during the recent PHA convention, Prof. Wenger, a well-respected professor of medicine with an astounding career dedicated to women’s health and health awareness that spans more than 50 years, affirmed that CVD kills a significant number of women. This is contrary to what some people might think that only males are at high risk for cardiovascular mortality.
She said that it remains as one of the top causes of mortality in women. Unfortunately, people are barely paying attention to it, mostly dismissing CVD as an elderly male disease entity, Prof. Wenger noted.
Until recently, it has been thought that women did not experience heart disease until they were old, and that they were not as seriously at risk as men were. Cardiovascular disease mortality trends in the United States, however, show a steady decrease in the mortality trend in men compared to that in women in the past three decades.
Only in 1992 have the knowledge gaps been identified in sex-based differences in CVD, Prof. Wenger shares. She further notes that it was only in 2001 that the need to evaluate and translate these differences into clinical practice was recognized.
Prof. Wenger moreover narrated that as time passed by, more studies and advocacies were born, focusing on and contributing to women’s cardiovascular health.
In 2003, studies disputed the “universal panacea” hormone therapy, which was not able to prevent incidence or recurrence of CVD in women, the lady doctor stated. Attention has then been refocused on establishing prevention and treatment for CVD in women.
In 2004, the American Heart Association came up with an impassioned social awareness campaign (Go Red For Women) to encourage women to take charge of their cardiovascular health and to dispel the myths regarding heart disease and stroke in women.
More studies have surfaced specifically on disease effects and prevention in women, as well as on their differences with men. The NHLBI-sponsored Women’s Ischemia Evaluation (WISE) study points out that ischemic heart disease kills women even in the absence of frank coronary obstruction. The studies Women’s Antioxidant Cardiovascular Study (WACS) and Women’s Antioxidant and Folic Acid Cardiovascular Study (WAFACS) noted that vitamins B, C, and E, beta carotene and folic acid supplementation did not prevent incident or recurrent CVD in women.
Interestingly, the 2011 AHA guidelines noted that pregnancy complications can be early indicators of CVD, underscoring that detailed history of pregnancy complications is of paramount importance in risk factor assessment.
Based on the Get with the Guidelines CAD Database, mortality rate is almost double for women (10.2 percent) than men (5.5 percent) with ST-elevation myocardial infarction (STEMI). Moreover, women encounter less early aspirin treatment, less beta blocker treatment, less reperfusion treatment, and even less timely reperfusion, likely because STEMI is under-recognized in women.
Women have worse prognosis with acute coronary syndrome (ACS), with greater bleeding risk with all therapies and interventions. They are also less likely to receive medical interventions despite high risk status. These studies show opportunities where there are gender disparities in care.
The 2010 IOM Report on Women’s Health Research: Progress, Pitfalls, and Promises also pointed out the need for greater research attention to quality of life issues for women. Women do not belong to a homogenous group, with disparities in disease burden among those with differing beliefs, race, ethnicity, income level, and educational attainment.
Prof. Wenger emphasized the need to delve into these social, economic, and even legal issues to better understand the state and progress of women’s heart health.
She called upon her colleagues in Philippine Cardiology to define their own journey, their own trajectory in this field, and in the process, inspire more young men and women to follow. She encouraged them to educate, advocate, and when necessary, to legislate for women’s heart health, a call to which former PHA President Dr. Maria Teresa Abola, the session chair and a member of the PHA Council on Women’s Health enthusiastically responded to.
June 2017 Health and Lifestyle