The European Society of Cardiology (ESC) today launches its new initiative Women at Heart at the Spring Meeting of its 49 National Cardiac Societies. Women at Heart is aimed at medical professionals, to highlight the growing burden and under-appreciation of women’s heart disease and promote improved handling of women at risk of cardiovascular disease in clinical practice.
Cardiovascular disease (CVD) is the primary cause of death in European women, killing a higher percentage of women (55%) even than men (43%) and more than all cancers combined. However, there still exists a disturbing gap in the knowledge, understanding, and general awareness of cardiovascular disease in women, not only in the women themselves, but across medical audiences as a whole. CVD is seen as a ‘male disease’ by the general public and, since women’s symptoms and disease progression trends differ from men’s, primary care physicians and cardiologists are all too frequently under-diagnosing and under-treating women, insufficiently familiar with their less ‘traditional’ presentation profiles.
Women are under-represented in clinical trials and their CVD clinical manifestations are less well charted and outlined to the medical professional in their initial or ongoing training. There is thus much to be done to increase the understanding of women’s CVD and improve the quality of treatment of women with CVD across Europe.
Women at Heart will include the following events and activities, organised by the ESC:
Professor Silvia Priori, of the Fondazione Salvatore Maugeri, Pavia, Italy, is the Chairperson of Women at Heart, as well as a member of the Board of the ESC. Professor Priori outlines the objectives of the initiative, “The ESC has tremendous potential, through its network of 49 countries, to pass on these crucial messages. By encouraging each of our National Cardiac Societies to take up the mission, there is great potential to increase the awareness of women’s cardiovascular disease patterns and directly improve the quality of care of women with heart disease and stroke across Europe”.
“We are very thankful to the Bristol Myers Squibb Foundation for their support of this initiative and their clear commitment to the importance of European women’s heart health. Through Women at Heart, we aim to highlight the issue of women’s cardiovascular disease on a European level and encourage national action, so that each European country can make women’s heart health a priority, both in their public policy and clinical practice”.
Professor Priori continues, “Certainly, the Women at Heart initiative is personally satisfying for me because, as a woman, I feel a moral obligation to advocate for the cause of women. It is important that we ensure that cardiovascular diseases in women are better understood and that the prevention of risk factors is actively promoted among female patients. This isnt womens lib but rather a necessity for good medical practice”.
“The analysis of our Euro Heart Survey databases in light of this initiative will be extremely interesting, as these are large databases on extensive European populations without the artificial representation so often seen in clinical trials”, says Professor Priori. “We have all the data at our fingertips and can reassess them in a relatively short time. These data are likely to give us important insights into manifestation, treatment and co-morbidity patterns, as well as hints on treatment and response trends, in women as compared to men. I am very much looking forward to the release of these data at our Stockholm Congress and am optimistic about the contribution these results will yield in increasing the understanding of women’s cardiovascular disease and improving treatment overall”.
Professor Michal Tendera of the Silesian School of Medicine, Katowice, Poland, President of the ESC, states, “The ESC mission is to improve the quality of life in the European population by reducing the impact of cardiovascular disease. We believe that the Women at Heart initiative will bring us all closer to the fulfilment of this mission".
Women are equal
The misconception that CVD is a male disease is rife across Europe and the rest of the world. In fact, in Europe, CVD is the main cause of death for both men and women.
CVD includes coronary heart disease and stroke and kills more people than all cancers combined. And yet, according to public awareness surveys, women seem to think that they are more at risk of cancer, especially breast cancer.
The under-estimation of the impact of CVD in women is however not confined to the public. Medical professionals equally need to improve the screening, diagnosis, treatment and follow up of women with CVD and its underlying risk factors.
CVD is cited as the primary cause (55%) of deaths in women in Europe, even more than in men (43%). Furthermore, whilst more men have strokes, women are more likely to die as a result of a stroke. As women tend to live longer than men, on average 5-6 years more, it is crucial to acknowledge the growing burden and implications of women’s CVD across Europe.
Professor Priori says, “Women think ‘I can smoke or over-eat’ as they have not seen their female peers having heart problems up to 50 years old. That’s because in women it strikes later, but it does strike. And then it is often too late, after years of unhealthy living, such as insufficient exercise and inappropriate diet. So women need to be better educated on the importance of heart-healthy lifestyles and sufficiently screened for risk factors before heart disease strikes”.
Women are different
Nevertheless, the presentation, progression and outcomes of CVD in women do differ from those in men. As a result, it is important that medical professionals are equally trained in recognising women’s risk profiles, disease onset and progression patterns as well as men’s.
Women’s symptom profiles often vary markedly from those of their male counterparts. Women with heart disease are up to ten years older than men and present with much less obvious and stereotypical symptoms. Both the general public and medical professionals need to be sensitive to women’s CVD symptom profiles and disease progression patterns, as these do not necessarily follow the more widely-known trends of men’s.
Women tend to get heart disease later than men due to the cardioprotective effects of oestrogen that plays an important role up until the menopause. However, after the menopause, the risks increase significantly and need to be delicately managed.
In many women, the onset of heart disease is more gradual, accompanied by tiredness, rather than the more commonly-recognised symptoms, such as sudden violent chest pain, that predominate in men. Furthermore, women with CVD are more likely to die or suffer disability from a re-attack or heart failure.
Professor Priori says, “The issue is not simply that men and women are different per se, but rather that there are specific differences between the genders in symptom profiles and responses to treatment that must be taken into proper account”.
Women are under-represented
Clinical trials are biased towards men as, to date, women have been grossly under-represented in clinical trial design, enrolment and analysis. This directly affects treatment practices, including recommendations on drug and procedure usage.
Professor Priori states, “We need more women in clinical trials. Cardiovascular disease is the leading cause of death in women and until women are sufficiently represented and analysed in landmark studies, the treatment and medical understanding of women’s heart disease will remain substandard”.
Women are under-treated
This shortage of crucial clinical trial information on women leads to inappropriate diagnosis and treatment of women with CVD. Physicians’ training is dominated by male data and trends, and guidelines focus on such data in recommending drug dosages and procedures. Thus women are being treated as if they are men, despite the notable differences in their disease elements.
Professor Priori says, “Doctors have formulas on pain in women and on heart disease symptoms but less training on non-typical pain or symptom patterns. They may misdiagnose a woman with heart problems as her symptoms do not follow the more typical ‘male’ patterns learned in training. Women’s patterns need to be better understood, outlined and reported to clinicians”.
Professor Priori says, “We look forward to working with our National Societies and the appropriate European authorities in addressing this crucial topic. We urge European clinicians to readdress their thinking and take note of our Women at Heart initiative and its messages, in order to improve the diagnosis and treatment of heart problems in women and increase the quality of clinical practice across Europe”.
Camilla Dormer | alfa
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