Heart Disease: Surgeries and Medical Advances

Women Are Undertreated for Heart Disease

This difference between men's and women's heart disease may partly explain why women are still underdiagnosed and undertreated, even though about the same number of women die each year of coronary artery disease (CAD) as men. In 2001, for example, 689,000 men had removal of a coronary artery obstruction with angioplasty or insertion of a stent, according to the Centers for Disease Control and Prevention, while only 363,000 women did. Similarly, 365,000 men had CABG, while only 151,000 women did.

"The question of whether there is bias against women in heart treatment has been around for some time, and in fact our data do show a bias against giving women more aggressive therapy," says Sujoya Dey, MD, a cardiologist at the University of Michigan Cardiovascular Center. A recent study, presented at the American Heart Association conference in November, showed that women who suffer chest pain or a heart attack have milder and more diffuse blockages in their major arteries than men. "But our findings also suggest that a small part of the difference in treatment may be understandable, because women's CAD appears to be different, sometimes occurring in vessels too small for angiography, angioplasty, or bypass."

"Despite these findings, the major percentage of bias against women and the lack of aggressive treatment when they have heart disease still remains to be explained," says Marianne Legato, MD, professor of clinical medicine at Columbia University College of Physicians and Surgeons and the founder and director of the Partnership for Gender-Specific Medicine at Columbia University, in New York City. "And it's not because women refuse care or treatment. That only accounts for 3 to 6 percent of the difference."

Women who do undergo heart surgery don't do as well afterward, either, says Viola Vaccarino, MD, a cardiovascular epidemiologist at Emory University, in Atlanta. Women, particularly younger women, have as much as three times the risk of dying during or shortly after CABG than men do, she reported in a 2002 study in Circulation: Journal of the American Heart Association. And women have a more difficult recovery than men after CABG, too, including more symptoms of anxiety and depression and a higher rate of infections and readmittance to the hospital for heart failure, according to her 2003 study published in the Journal of the American College of Cardiology. Dr. Oz says women often have more advanced conditions by the time they're referred to a surgeon, "perhaps because they were not evaluated aggressively enough in the beginning."

But the news is not all bad for women with CAD, says Dr. Oz. If angioplasty isn't possible for you and surgery is indicated, there are amazing new surgical techniques that are less invasive than previous techniques, cause less pain, and may allow faster, and better, recovery.