WOMEN'S HEALTH
June 2, 2020

A Woman's Heart

Women's hearts don't get the respect they should. Too often issues like hypertension and high cholesterol are left un- or under-treated.

The fact that there is a big difference when it comes to diagnosing and treating cardiovascular disease (CVD) in men and women is well documented. Studies have found important disparities between men and women in the prescribing of drugs to treat CVD. For example, women are less likely than men to receive high-intensity statins after hospitalization for a heart attack.

Most of the findings on differences between men and women in the management of cardiovascular disease have come from studies done in hospitals or secondary care settings. But what about care in the doctor's office, a primary care setting?

Primary care doctors prescribed women certain CVD medications at significantly lower rates than men.

A team of researchers set out to see if there were gender differences in treating CVD at appointments with patients' primary care physicians, before hospitalization among patients who are either at high risk for, or who have, CVD. “We need to reduce the persistent treatment gaps between men and women,” researcher, Sanne Peters, said in a statement. A better understanding of gender differences in the prescribing of CVD medications in a primary care setting would help both doctors and their patients make the best use of these drugs.

The Study
The researchers systematically reviewed two medical databases to identify studies tracking the number of prescriptions for cardiovascular medications for both men and women. They looked specifically for the number of prescriptions for aspirin, which reduces the risk of blood clots; statins, which lower cholesterol; and drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and diuretics, which lower blood pressure.

A total of 43 studies involving almost 2.3 million people worldwide were included in the final analysis. The mean age of participants in these studies ranged from 51 to 76 years old.

Primary care doctors prescribed women certain CVD medications at significantly lower rates than men. Women received 19 percent fewer prescriptions for aspirin, 10 percent fewer prescriptions for statins and 15 percent fewer prescriptions for ACE inhibitors compared to men. Women were 27 percent more likely than men to be prescribed diuretics, however.

There are a number of reasons behind this prescribing gap. The incidence of CVD among middle-aged women is about a third of that among middle-aged men, according to the researchers. And CVD occurs in men about a decade earlier than it does in women. Gender differences in the progression and presentation of CVD and concerns about side effects may lead doctors to choose alternative antihypertensive, or blood pressure-lowering regimens.

Women in particular should be more proactive about having their concerns about CVD addressed at their primary care visits.

Because cardiovascular problems tend to arrive later and are less common among women, women themselves may be less aware of the possible severity of their disease and the need to seek appropriate CVD treatment than men are. As a result, they may use healthcare services less frequently. The fact that fewer women approach doctors seeking information and testing regarding cardiovascular issues may contribute to the misperception that CVD is less common in women than men and does not need to be treated as aggressively in women.

Everyone should talk with their doctors about what they can do to prevent CVD and the possible need for medications to manage cholesterol and blood pressure, but women in particular should be more proactive about having their concerns about CVD addressed at their primary care visits. “Patients should talk with their doctor about the benefits of taking CVD medications, and weigh these benefits against the risks,” said Peters, a research fellow in epidemiology at the George Institute for Global Health at the University of Oxford in the United Kingdom. Providers, too, need to make more of an effort to make sure both men and women who need CVD medication receive the appropriate prescription, he added.

The study is published in the Journal of the American Heart Association.

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