Women and Heart Disease
Patlak, Margie, FDA Consumer
In the spring of her 58th year, Anita Chudnow of Milwaukee, Wis., was working in her garden when a sudden and extreme fatigue overcame her. She went in to lie down and didn't have the energy to get up to make dinner several hours later.
Convinced that something was amiss, her family insisted she see a doctor. He put her through a battery of tests, which revealed that three of Chudnow's heart arteries, called coronaries, were choked with a fat-like deposit called plaque. The plaque had narrowed her arteries, depriving her heart of the oxygen-rich blood it needed to function.
"I couldn't believe it," said Chudnow, recalling her surprise at learning she had coronary heart disease, although she was familiar with the condition because her father had it. "Maybe I thought heart disease was a man's disease because of all those years my father suffered from it. I went with him in the ambulance to the hospital so many times and I never thought the same thing could happen to me," she said.
Unfortunately, Chudnow isn't the only one with that misconception. Although heart disease has been the number one killer of women since shortly after the turn of the century when it overtook infectious diseases, most people aren't aware of how common--and how deadly--the disorder is in women.
"This is a problem," said cardiologist Nanette Wenger, M.D., of Emory University in Atlanta, "because unless women see heart disease as part of their disease profile, they're not going to adhere to heart disease prevention messages early in life and they're not going to respond to heart disease symptoms later on."
The lack of awareness of heart disease in women was fueled, in part, by the early findings of the landmark Framingham Heart Study. In this study, which began in 1948 and is still ongoing, researchers have scrutinized the habits and health of thousands of middle-aged men and women from Framingham, Mass. After collecting data for a little over a decade, they found that three times more men died from heart disease during this period than women, which led to the conclusion that women were somewhat protected from the condition.
Further analyses of the Framingham data and a study conducted at the Cleveland Clinic revealed, however, that women aren't spared from medical matters of the heart, but rather tend to develop them about 10 to 15 years later in life than men. According to the American Heart Association, 1 in 9 women aged 45 to 64 has some form of heart or blood vessel disease; this ratio soars to 1 in 3 at age 65 and beyond. The approximately 500,000 heart attack deaths that occur annually in this country, in addition, are evenly split between men and women. Each year, nearly twice as many women die from heart disease and stroke than from all forms of cancer combined.
Despite the prevalence and seriousness of heart disease among women, much of what is known and popularized about it is based on research done in men. The studies that have included women suggest, however, that many of the mainstays of diagnosis, treatment and prevention of coronary heart disease may not apply to the female gender.
As with other drugs and populations, FDA is responsible for the safety and effectiveness in women of medications for heart disease.
Discrepancies in Diagnosis
One of the telltale signs of heart disease is chest pain or tightness, known as angina, that occurs during physically demanding tasks such as climbing stairs, or under emotional strain. This pain can make a person short of breath. It can radiate to the jaw, neck, shoulders, or inner arms. Angina occurs because narrowed arteries in the heart deprive it of oxygenrich blood. If a blood clot completely chokes off the blood supply in these arteries in what is known as a heart attack, chest pain usually becomes more severe and lasts longer.
But chest pain may not be as good a diagnostic clue of serious heart disease in women as it is in men. …