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Equal rights for equal risk.

Two studies reported in the New England Journal of Medicine last July emphasized the need for greater awareness of the risk of coronary artery disease in women. Because the disease is very uncommon among premenopausal women, females have garnered considerably less medical attention than males, in terms of both prevention and treatment of heart disease.

One of the studies, from the Harvard Medical School, involved more than 83,000 cases. Researchers found, for example, that doctors were about 10 times more likely to recommend angiography after a positive stress test for a man than for a woman. Angiography is an invasive diagnostic technique in which x-ray-detectable dye is injected into the coronary arteries through a thin catheter threaded into the heart through an artery in the arm or the leg. The x-ray thus detects blockage in the coronary arteries. Because there is some risk to the procedure, and because doctors generally assume that females are far less likely than males to have coronary artery disease, some doctors are reluctant to subject their female patients to this additional risk after a positive stress test.

In the other study, data from 112 American and Canadian hospitals showed that a woman was not likely to receive equal treatment for suspected heart disease until she actually had a heart attack. Even then, women were half as likely to have surgery, although drug treatment for angina was about the same for both men and women.

What, then, is the risk of coronary artery disease in women and what ought they do to prevent it? After menopause, women begin to develop cardiovascular disease at a rate that soon approaches that of men. For example, the rate for women aged 60 is about the same as that for men 10 years younger, but by age 75 or 80, the rates are the same. After age 75, heart disease kills more women than does cancer.

The hormone estrogen appears to protect women from heart disease in their earlier years, but exactly how it does this is not yet clear. Last September, the NEJM published a report on 50,000 postmenopausal nurses who, after taking estrogen, reduced their heart disease risk by 50 percent. Other studies, however, have suggested an increased risk of breast cancer and cancer of the endometrium (the lining of the uterus) with estrogen therapy. Many doctors are now using a combination of low-dose estrogen and a synthetic form of another female hormone, progesterone, to treat the hot flashes and other symptoms of menopause.

Preventive measures for women are the same as those for men, although some are given more emphasis. Smoking, for example, is probably the greatest hazard. Two-thirds of the heart attacks that do occur among younger women are attributed to cigarettes. Moreover, the association of birth control pills and heart disease occurs only among women who smoke. Women who give up smoking altogether will lower their risk to those of nonsmokers in only two years.

Family history is another important consideration. Get regular checkups if close relatives have had heart disease-especially if before 50-and if you're black. Exercise regularly, follow a low-fat diet, and bring your weight back toward normal if overweight. Have blood pressure and cholesterol checked regularly. Finally, don't settle for anything less than equal care if your doctor thinks you have a cardiovascular problem!
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Title Annotation:coronary artery disease in women
Publication:Medical Update
Date:Mar 1, 1992
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