Greater emphasis on preventing, treating heart disease in women needed

Women and physicians do not put enough emphasis on cardiovascular disease in women, and a social stigma regarding body weight may be a primary barrier to these important discussions, according to research publishing today in the Journal of the American College of Cardiology.

Cardiovascular disease is the number one cause of death in the United States, accounting for nearly 400,000 deaths and killing more women than all types of cancer combined. Although there has been a decline in overall mortality from heart disease, this decrease has been smaller for women compared to men and the death rate in women younger than 55 years old has increased.

"Increasing awareness of cardiovascular disease in women has stalled with no major progress in almost 10 years, and little progress has been made in the last decade in increasing physician awareness or use of evidence-based guidelines to care for female patients," said Bairey Merz, director of the Barbra Streisand Women's Heart Center in the Cedars-Sinai Heart Institute and the study's lead author.

For this study, researchers from the Women's Heart Alliance interviewed 1,011 U.S. women aged 25-60 years and collected physician survey data from 200 primary care physicians and 100 cardiologists. The goal of the surveys was to determine knowledge, attitudes and beliefs regarding heart disease in women.

The researchers found that 45 percent of women were unaware that heart disease is the number one killer of women in the U.S. Awareness level was lower in women with lower levels of education and income and in ethnic minorities. Nearly 71 percent of women almost never brought up the issue of heart health with their physician, assuming their doctor would raise the issue if there was a problem. However, physicians were more likely to discuss cardiovascular health if prompted by the patient or due to the presence of a risk factor.

Physicians often did not discuss cardiovascular disease because the patient had a more immediate health issue or did not fully report their symptoms, indicating that prevention prior to symptoms was not a priority. Women who knew someone with heart disease were more likely to express concern and bring this issue up with their physician or to discuss heart disease with a friend thought to be at risk for having or developing heart disease.

While a majority of women reported having a routine physical or wellness exam in the past year, only 40 percent reported having a heart health assessment. While 74 percent reported having at least one risk factor for heart disease, just 16 percent were told by their doctor that they were at risk. Sixty-three percent of women admitted to putting off going to the doctor at least sometimes and 45 percent of women canceled or postponed an appointment until they lost weight. Many women reported being embarrassed or overwhelmed by their heart disease and many also cited difficulties in losing weight or finding time to exercise.

Only 22 percent of primary care physicians and 42 percent of cardiologists felt well prepared to assess cardiovascular risk in women. Additionally, only 16 percent of primary care physicians and 22 percent of cardiologists fully implemented guidelines for risk assessment.

"These findings suggest a need to destigmatize cardiovascular disease for women and counteract stereotypes with increased objective risk factor evaluation education to improve treatment by physicians," Bairey Merz said. "National action campaigns should work to make cardiovascular disease 'real' to American women and destigmatize the disease by promoting the use of cardiovascular risk assessment to counter stereotypes with facts and valid assessments."

In an editorial comment published with the paper, Jennifer G. Robinson, MD, MPH, from the College of Public Health at the University of Iowa discusses the importance of developing healthy lifestyle habits early in life to reduce the risk for cardiovascular disease.

"Helping women overcome barriers to increasing physical activity and healthier eating habits may help to avoid the stigma of focusing on weight loss," she said. "Women are often the gate-keepers for family meals, activities and health care, and a focus on healthy lifestyle habits may also encourage early prevention in the family as a whole."