Heart disease: Women and men receive different advice for prevention

  • New research suggests that doctors may treat women and men differently when it comes to preventing heart disease.
  • The analysis shows that men were 20% more likely to be prescribed statins compared to women.
  • Women were also 27% more likely to be advised to lose weight and 38% more likely to receive recommendations to exercise than men.
  • Heart disease is a leading cause of death for men and women — and the guidelines for maintaining heart health should be similar, regardless of biological sex or gender.

The recommendations for heart health are fairly universal, but not everyone may receive the same guidance.

In fact, prior research, such as this 2020 study, suggests that healthcare professionals may treat women who’ve had a heart attack less aggressively than men.

Now, a new study suggests that doctors may prescribe medication less frequently to women to prevent cardiovascular disease (CVD).

“Our study found that women are advised to lose weight, exercise, and improve their diet to avoid cardiovascular disease but men are prescribed lipid-lowering medication,” study author Dr. Prima Wulandari, a cardiology clinical researcher at Harvard Medical School and Massachusetts General Hospital, said in a press release.

The study was recently presented at the European Society of Cardiology Asia 2022 conference in Singapore.

Why are men and women given different medical advice?

Experts say that men and women have historically been treated differently in various healthcare settings — but why?

Dr. Martha Gulati, director of preventive cardiology at the Smidt Heart Institute at Cedars-Sinai in Los Angeles, CA, and president of the American Society for Preventive Cardiology, told Medical News Today she’s witnessed discrepancies in how men and women are treated in healthcare settings over the course of her medical career.

“We allow women who have high blood pressure to be untreated,” Dr. Gulati said.

“We see it attributed to stress, but still, medications aren’t prescribed. Even after a woman has a heart attack, she is less likely than a man to get guideline-directed therapies. Having a heart attack should be enough to get you all the life-saving medications. But it is not the case for women, and we know this globally.”

Dr. Gulati added that she wasn’t surprised by the new research.

“We have other data supporting that we treat men more aggressively than women for both primary and secondary prevention of cardiovascular disease. Statin and lipid-lowering therapies are particularly underutilized [in] women.”

– Dr. Martha Gulati, cardiologist

Dr. April Stempien-Otero is a cardiologist at the Heart Institute at UW Medical Center and UW associate professor of medicine in the division of cardiology and the Craig Tall Family Endowed Professor in Heart Failure Research.

She echoed Dr. Gulati’s observations and told MNT that when female patients are referred to her, she’s noticed they’re less likely to be prescribed statins by their doctors compared to male patients.

Studying differences in heart health recommendations

Dr. Wulandari sought to find out whether doctors treat women and men equally when it comes to preventing heart disease.

For the analysis, Dr. Wulandari examined data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES), which combines interviews and physical examinations to assess the health of children and adults in the United States.

Dr. Wulandari used the ASCVD Risk Estimator to estimate the 10-year risk for developing CVD for 8,512 NHANES healthy participants between the ages of 40 and 79.

Of those participants, 2,924 had a score indicating an increased risk for CVD development that qualified the patients to receive statins. Participants who had a history of CVD events or diagnoses were excluded from the research.

Dr. Wulandari calculated the odds of male participants compared to female participants being prescribed statin therapy and receiving advice to lose weight, exercise, reduce salt intake, and reduce fat or calorie consumption.

She adjusted the analyses for age, risk of CVD, body mass index, resting heart rate, depression score, and educational attainment.

The analysis shows that men were 20% more likely to be prescribed statins than women to prevent heart disease. Doctors were also 27% more likely to tell female patients to lose weight and 38% more likely to advise female patients to exercise than male patients.

As for diet, female patients were 27% more likely to receive instructions to cut salt intake and 11% more likely to be told to cut fat or calories than male patients.

A strength of Dr. Wulandari’s reporting, according to Dr. Stempien-Otero, is the use of the risk estimator.

“The risk calculators are supposed to take away that intrinsic bias we have when we look at a patient in front of us and say, ‘Oh, they couldn’t have this’ or ‘They couldn’t have that,’” Dr. Stempien-Otero said. “I think It reemphasizes how important it is for us to use quantitative data in assessing risk in our patients.”

Medication and behavioral interventions needed

People at a higher risk of developing heart disease should be prescribed medication and behavioral interventions no regardless of their biological sex or gender, Dr. Gulati said.

“We are partners with our patients and we need to have frank discussions about the risk for cardiovascular disease and provide the options for therapy,” Dr. Gulati said.

“This includes both lifestyle modifications and medications. Shared decision making should be used, rather than us making assumptions about our patient’s preferences.”

Dr. Gulati wondered whether some healthcare professionals may perceive that women are at a lower risk for heart disease, even despite the similar risk scores for both men and women. She questioned what some healthcare professionals may be thinking during their clinical assessments.

“Do we think women will be more able to change [their] lifestyle? Or that they have more potential lifestyle [or] behaviors that should be modified compared with men?” Dr. Gulati asked.

She also proposed that perhaps some doctors may believe that women prefer lifestyle modifications over taking medications.

The myth that women face a lower risk for CVD

Dr. Wulandari also conducted a literature review for her presentation in Singapore.

“This demonstrated that a potential root of the discrepancy in advice is the misconception that women have a lower risk of cardiovascular disease than men,” she said in the press release.

But almost as many women as men die of heart disease in the United States each year, according to the Centers for Disease Control and Prevention (CDC).

As the leading cause of death for women, heart disease was responsible for 1 in 5 female deaths in 2020.

“The risk for cardiovascular disease remains underappreciated in women,” Dr. Gulati said.

“And women remain undertreated. It should be of no surprise if we continue to approach women so differently from men, in terms of aggressiveness of treating cardiovascular risk factors, we will continue to have this preventable disease continue to rise in women.”

Addressing sex and gender bias

Dr. Stempien-Otero said she’s often asked what to do by women who’ve had concerns about palpitations or chest pain dismissed by healthcare practitioners as being anxiety.

“I tell them not to take no for an answer — I tell them to keep advocating for themselves with their primary care doctors. I tell them to look for women’s heart health clinics, and those are increasing around the country,” she said.

Dr. Stempien-Otero asserted that healthcare practitioners need to receive more education about female-specific risk factors for heart disease.

She pointed to how preeclampsia during pregnancy may double a person’s chances for later heart failure and how women who survive breast cancer are more likely to die of heart disease than a cancer recurrence.

Cardiology as a whole needs to recruit more women, Dr. Stempien-Otero stated. In fact, only around 10–15% of cardiologists are female, according to the American College of Cardiology.

“It’s a very male-dominated field, so I’d also encourage women to find a woman cardiologist if they feel like they’re not getting [a high] level of care,” Dr. Stempian-Otero said.

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