YOU ARE HERE: LAT HomeCollections

Medicine Turning Its Attention to Women and Heart Disease : Health: After decades of believing heart-attack risks were greater for men, doctors now think differently. After menopause, experts say, the odds even out.


The myth began in the small community of Framingham, Mass.

There, in the late 1940s, a sweeping, government-funded study began to track the cardiovascular health of thousands of men and women, noting what they ate, how they lived and from what they died.

Early in the now-famous Framingham Heart Study, researchers noticed that men began suffering heart attacks in middle age, while women seemed unaffected. The experts guessed that because women have high levels of the hormone estrogen, they were protected against heart disease.

"The early conclusion from that study was that women were not suffering from heart attacks, that women are immune due to estrogen," says Dr. Edward B. Diethrich, medical director of the Arizona Heart Institute and author of the new book "Women and Heart Disease."

That explanation was accepted as fact. Two decades later, while in medical school, Diethrich recalls a professor telling him: "Don't worry about women."


Physicians now recognize that while estrogen--or something--does seem to protect most women against heart disease in the first half of life, after menopause the rate of heart disease soars in women and is almost equal to the rate in men by age 65. For example, men age 65 and older suffer an estimated 440,000 heart attacks each year, compared to 374,000 in women age 65 and older.

But many women still do not get prompt diagnosis and treatment of heart disease, experts say. And many women have failed to educate themselves about the risks and warning signs.

"If you ask doctors what the biggest killer of women is, I think a lot of doctors would give the wrong answer," Diethrich says. Heart disease is the leading killer in women, accounting for 240,497 deaths in 1989, the last year for which statistics were available.

"And most women don't realize that once you are post-menopausal, the risk is equal (to men)," he says.

Many of the studies on heart disease have been done on men, leaving physicians with a serious lack of understanding of the disease in women, Diethrich says.

He tells two stories to illustrate the persistence of the myth: In one case, a woman came to an emergency room four times complaining of chest discomfort. Her complaints were dismissed as stress-related. It's "nerves," she was told.

The next time the pain hit, she didn't make it to the emergency room--and she died, Diethrich says.

In another case, a women frantically drove her husband to the emergency room because he had chest pain. While waiting for her husband to be checked, she suffered from an attack of pain. Physicians rushed to attend to her, but she waved them off.

"She said, 'It was nothing. I'm here for Sam,' " Diethrich recounts. The doctors persuaded the woman to submit to an exam and, Diethrich says, "We operated on this woman for heart disease three days later."

Efforts never have been greater, however, to close one of medicine's most embarrassing gender-based knowledge gaps. Already this year several studies have advanced the understanding of heart disease in women. And the recent annual American College of Cardiology meeting in Anaheim gave the gender issue top billing.

"We've called attention to this problem," says Dr. C. Noel Bairey Merz, director of the Preventative and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center. "Now, we need to do more studies in women. And, in addition, we have previous studies that can be looked at now with a new angle."

Recent studies point to the obvious need for better diagnosis and treatment of women:

* According to the largest national registry of heart-attack patients, women over age 70 are more likely to suffer heart attacks than men of same age (56.5% compared to 32.7%).

* Studies also show that early treatment with thrombolytic, or clot-busting, therapy offers the best chance of survival. But a recent survey found that women were less likely to be treated with such drugs within four hours of the start of chest pains. Not surprisingly, women with delayed treatment were more likely to die.

* Women who undergo angioplasty, in which a tiny balloon is used to clear clogged arteries, are 10 times more likely to die in the hospital. The female angioplasty patients were more likely to be older and sicker than men. But even after age-related risk factors were taken into account, women were still 4.5 times more likely to die in the hospital. Doctors are puzzled by this and are calling for more studies to determine possible reasons for the higher death rates.

* Symptoms of heart attack in women may differ from men, according to research released last month. While a man may experience a crushing chest pain that radiates through the chest or left arm, a woman may have a more lingering pain, vague chest discomfort and nausea.

"Because all the (early) studies on heart disease were done in men, what we call typical is a man's standard," says Bairey Merz. "The standard may be different for women. We need to tell older women it may feel different."

Los Angeles Times Articles