Men and women differ in matters of the heart

Updated 11:00 AM November 17, 2003

Research: U-M presents findings at American Heart Association event

Men and women differ in matters of the heart

By Kara Gavin
UMHS Public Relations

A new study shows just how different men and women really are—when it comes to their hearts, that is. It also helps solve several mysteries about women and heart problems, and highlights the need for better treatment of the No. 1 killer of women.

The study, led by researchers from the Cardiovascular Center, shows that women who suffer chest pain or a heart attack are more likely than men with the same conditions to have only mild and more diffuse blockages in their major arteries. This means that for these individuals, their symptoms are most likely caused by blockages in smaller, less flexible vessels.

But even when men and women with similar rates of heart attack were compared, the women were less likely to get aggressive drug treatment, according to the new results from the Global Registry of Acute Coronary Events presented in Orlando last week at the American Heart Association's (AHA) Scientific Sessions 2003.

Coronary heart disease is the single leading cause of death among American women.

Since women's large blood vessels were more likely to be clear when examined via angiography, the authors think they may have found the reason so many women with acute heart symptoms leave the hospital without a firm diagnosis and with a less aggressive therapy regimen.

The finding also may explain a long-known but mysterious disparity between men and women in the rate of angioplasty and bypass surgery, which are most often done only after severe blockages or narrowings are spotted on an angiogram.

But the researchers were especially surprised by the disparity in drug therapy, including the use of aspirin, beta-blockers and clotbusters in the hospital, and aspirin and beta-blockers at discharge. Such drugs are recommended for nearly all people who suffer heart attacks.

"The question of whether there is some sort of bias against women in heart treatment has been around for some time, and in fact our data do show a bias against giving women more aggressive therapy," says Dr. Sujoya Dey, the U-M cardiology fellow who led the analysis.

"But our findings also suggest the bias may be understandable, because women's coronary artery disease on average appears to be different," she says. "It's more likely to be diffuse, occurring in vessels too small for angiography, angioplasty or bypass."

Dr. Kim Eagle, clinical director of the Cardiovascular Center, was the senior author of the study.

Coronary heart disease, which includes heart attack and angina, is the single leading cause of death among American women, killing 254,630 in the year 2000, according to AHA. About 210,000 women will have a heart attack this year, and angina affects 4.1 million women (compared with 2.5 million men). In all, 6.6 million American women alive today have a history of heart attack, angina or both. Still, Dey and Eagle say, women tend to think of heart disease as a man's problem.

Among the other findings researchers from the Cardiovascular Center reported at the AHA Scientific Sessions:

• A single hour of individualized education before heart failure patients leave the hospital appears to make a major difference in how well they take care of themselves once they get home—and cuts by one-third their risk of returning to the hospital or dying in the next six months.

Cardiologist Dr. Todd Koelling, assistant professor of internal medicine at the Medical School, was the lead author of the study; registered nurse Monica Johnson, a clinical research coordinator, conducted patient education sessions; and Drs. Keith Aaronson and Robert Cody were co-authors;

• Mass suicide by protective cells that line every blood vessel in the body may be to blame for the increased risk of heart and vascular disease faced by patients with the autoimmune disease lupus. And the test used to see those dying cells in the bloodstream one day may help lupus patients—and people with other diseases—understand, predict and do something about their personal risk of heart disease.

Dr. Sanjay Rajagopalan, a vascular medicine specialist and associate professor of internal medicine, was lead author. Rheumatologist Dr. Mariana Kaplan, assistant professor of internal medicine at the Medical School, was senior author.

The U-M research team also included Emily Somers, Dr. Robert Brook, Christine Kehrer, Dana Pfenninger, Robert Pavlic, Emily Lewis, Anjan Chakrabarti, Dr. Bruce Richardson, Eric Shelden and Dr. William McCune. The study was funded by the Lupus Research Institute, the Arthritis Foundation, and the Herbert and Carol Amster Lupus Fund;

• An innovative procedure completely cures the overwhelming majority of patients with atrial fibrillation, the most common form of irregular heartbeat, by stopping haywire electrical signals in areas of heart muscle and some of the veins that connect to it.

In several presentations at the AHA meeting and a new paper in the journal Circulation, lead author Dr. Hakan Oral, a cardiologist, reported on the dramatic success in treating atrial fibrillation patients using a technique called radiofrequency catheter ablation.

Dr. Fred Morady, also a cardiologist, is the senior author. Research is funded by the Ellen and Robert Thompson Atrial Fibrillation Research Fund. Oral and Morady have served as consultants and speakers for Biosense-Webster, the company that makes the catheter that detects the electrical impulses in heart and vein tissue. The other authors are Drs. Christoph Scharf, Aman Chugh, Burr Hall, Peter Cheung, Eric Good, Mehmet Ozaydin, Srikar Veerareddy and Frank Pelosi Jr.

Research: U-M presents findings at American Heart Association event

Men and women differ in matters of the heart

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