Women's Health Highlights [1]: Cardiovascular Disease - Recent Findings

Women's Health Highlights: Recent Findings
Program Brief

This program brief summarizes findings from a cross-section of AHRQ-supported research projects focusing on women's health topics published January 2006 through December 2009.

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Introduction

At the beginning of the 20th century, U.S. women were most likely to die from infectious diseases and complications of pregnancy and childbirth. In 2006, the chronic conditions of heart disease, cancer, and stroke accounted for 55 percent of American women's deaths, and they continue to be the leading causes of death for both women and men.

Women have a longer life expectancy than men, but they do not necessarily live those extra years in good physical and mental health. On average, women experience 3.1 years of reduced physical functioning at the end of life, and in 2008, 14 percent of women aged 18 and older who were surveyed said they were in fair or poor health.

The Agency for Healthcare Research and Quality (AHRQ) supports research on all aspects of health care provided to women, including:

* Enhancing the response of the health system to women's needs.
* Understanding differences between the health care needs of women and men.
* Understanding and eliminating disparities in health care.
* Empowering women to make well-informed health care decisions.

This summary presents findings from a cross-section of AHRQ-supported research projects on women's health published January 2006 through December 2009. An asterisk (*) at the end of a summary indicates that reprints of an intramural study or copies of other publications are available from the AHRQ Clearinghouse.

Go to the last page of this brief to find out how you can get more detailed information on AHRQ's research programs and funding opportunities.

Cardiovascular Disease

Heart disease is the number one killer of women in the United States. More than one-fourth of all deaths among U.S. women in 2006 were due to heart disease, which usually occurs about 10 years later in life in women than in men. Heart disease mortality differs substantially among women of different races, and almost two-thirds of women who die suddenly of coronary heart disease have no previous symptoms.

* Association found between cardiac illness and prior use of a certain type of breast cancer drug.

According to this 16-year study of nearly 20,000 women with breast cancer, those who received chemotherapy that included anthracycline had a higher incidence of congestive heart failure, cardiomyopathy, and dysrhythmia than women who received other kinds of chemotherapy or no chemotherapy. For example, the probability of experiencing congestive heart failure in year 10 was 32 percent for women who received anthracycline, compared with 26 percent for women who received other types of chemotherapy and 27 percent for those who received no chemotherapy. Du, Siz, Liu, et al., Cancer 115(22):5296-5308, 2009 (AHRQ grant HS16743).

* Women are more likely than men to experience delays in emergency care for cardiac symptoms.

Researchers examined time-to-treatment for 5,887 individuals with suspected cardiac symptoms who made a call to 911 in 2004. They found that on average, women arrived at the hospital 2.3 minutes slower than men. Factors increasing the likelihood of delay included evening rush hour travel, bypassing a local hospital, and living in a densely populated neighborhood. Even after adjustments were made for these factors, women were significantly more likely than men to be delayed. Concannon, Griffith, Kent, et al., Circ Cardiovasc Qual Outcomes 2:9-15, 2009 (AHRQ grants HS10282, T32 HS00060).

* Postmenopausal women with metabolic syndrome are at increased risk for a cardiovascular event.

Researchers used data on 372 postmenopausal women to investigate the effects of using two competing clinical definitions of metabolic syndrome on their usefulness in identifying women at high risk of future heart attacks or stroke. Metabolic syndrome—a combination of high blood pressure, elevated blood glucose, abnormal lipid levels, and increased waist size—is known to be associated with elevated risk for heart attack and stroke. Overall, women who met at least one of the definitions for metabolic syndrome were significantly more likely to experience a cardiovascular event than those who did not, and there was no difference between the two definitions in their predictive ability. Brown, Vaidya, Rogers, et al., J Womens Health 17(5):841-847, 2008 (AHRQ grant HS13852).

* Aspirin therapy to prevent heart attack may have different benefits and harms in men and women.

The U.S. Preventive Services Task Force reviewed new evidence from NIH's Women's Health Study and other recent research and found good evidence that aspirin decreases first heart attacks in men and first strokes in women. The Task Force has issued a recommendation that women between the ages of 55 and 70 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. The recommendation and other materials are available at http://www.USPreventiveServicesTaskForce.org/uspstf/uspsasmi.htm. Exit Disclaimer U.S. Preventive Services Task Force, Ann Intern Med 150(6):396-404, 2009 (AHRQ supports the Task Force). See also Optowsky, McWilliams, and Cannon, J Gen Intern Med 22:55-61, 2007 (AHRQ grant T32 HS00020).

* Women are more likely than men to be hospitalized for unexplained chest pain.

Data show that in 2006, there were 477,000 admissions of women to U.S. hospitals for unspecified chest pain—feeling of pressure, burning, or numbness—compared with 379,000 admissions for men. Although it is not clear why women receive this diagnosis more than men, there is some evidence that heart disease develops differently in women and men, and their symptoms may differ. Go to HCUP Facts and Figures 2006, online at http://www.hcup-us.ahrq.gov/reports/factsandfigures.jsp (Intramural).

* Female and black stroke patients are less likely than others to receive preventive care for subsequent strokes.

A third of stroke survivors suffer another stroke within 5 years, and there are several therapies to prevent further strokes in these patients. According to this study of 501 patients hospitalized for stroke, 66 percent of women and 77 percent of blacks received incomplete inpatient evaluations, compared with 54 percent of men and 54 percent of whites. Also, women were more likely than men to receive incomplete discharge regimens (anticoagulants and other stroke prevention medications and outpatient followup). Tuhrim, Cooperman, Rojas, et al., J Stroke Cerebrovasc Dis 17(4):226-234, 2008 (AHRQ grant HS10859).

* Process-of-care variables may explain some of the male-female differences in cardiovascular disease outcomes.

Researchers analyzed seven cardiovascular disease (CVD) quality of care indicators in a national sample of managed care plans and found inadequate lipid control in both men and women, with a lower rate of control in women. Also, women with diabetes were 19 percent less likely than men to have their LDL cholesterol controlled; women with a history of CVD were 28 percent less likely than men to have their LDL cholesterol controlled. More women than men had their blood pressure controlled, although the difference was small (2 percent). Chou, Scholle, Weisman, et al., Women's Health Issues 17:120-130, 2007 (AHRQ contract 290-04-0018).

* Commercial health plans show disparities between women and men in cardiovascular care.

Researchers evaluated plan-level performance of seven quality of care measures for CVD and found that over half of the plans showed a disparity of 5 percent or more in favor of men for cholesterol control measures among people with diabetes, a recent CVD procedure, or heart attack. The greatest disparity (9.3 percent in favor of men) was among those with recent acute cardiac events; none of the plans showed disparities in favor of women. Disparities between women and men were even greater among Medicare managed care plans. Chou, Wong, Weisman, et al., Women's Health Issues 17:139-149, 2007 (AHRQ contract 290-04-0018). Go to also Bird, Fremont, Bierman, et al., Women's Health Issues 17:131-138, 2007 (AHRQ contract 290-00-0012).

* Women continue to fare worse than men in treatment for heart attack and congestive heart failure.

According to this study of gender disparities among adults age 65 and older, women with acute myocardial infarction (AMI) or congestive heart failure (CHF) do not receive the same care as men. Also, women or men who have other medical conditions associated with AMI or CHF—such as diabetes, hypertension, or end-stage renal disease—do not receive better quality of cardiovascular care than those who have only the heart conditions. Correa-de-Araujo, Stevens, Moy, et al., Women's Health Issues 16(2):44-55, 2006 (AHRQ Publication No. 06-R042)* (Intramural).

* Immunosuppression related to transfusion may explain women's increased risk of dying after CABG surgery.

A study of more than 9,000 Michigan Medicare patients found that women undergoing coronary artery bypass graft (CABG) surgery were 3.4 times as likely as men to have received blood transfusions and generally received more units of blood, after accounting for age, coexisting conditions, and other factors. Patients who received a transfusion were more than three times as likely to develop an infection as those who did not, and they were 5.6 times as likely to die within 100 days after surgery. The presence of foreign leukocytes in donor blood may suppress the immune system of the recipient and thus increase the risk of postoperative infection, note the researchers. Rogers, Blumberg, Saint, et al., Am Heart J 152:1028-1034, 2006 (AHRQ grant HS11540).

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Women's Health Highlights: Recent Findings