A mistaken belief that coronary heart disease (CHD) affects only middle-aged men could be the reason why both women and younger people with the disease are not receiving optimal care, say Australian researchers.
Their large-scale analysis into general practice care found that many living with CHD are under-prescribed recommended medications, are not monitored for major risk factors and have treatments that do not achieve recommended goals.
Women and those aged less than 45 years were more likely to be under-treated compared with similarly affected men and older people.
The study, which is published in the journal Heart, analysed GP records of 130,926 patients with a history of CHD from 2014 to 2018.
Our study shows that people with a history of CHD, particularly women and people aged less than 45 years, are less likely to have their condition managed according to current clinical guidelines,” says lead researcher Rachel Huxley from La Trobe University.
“Despite the differences in CHD management, women were more likely to achieve treatment targets than men.”
The study found that women were less likely than men to be prescribed any of the four recommended medications for CHD – antiplatelet agents, ACE inhibitors, beta-blockers and statins. Just 22% of women were prescribed all four, compared with 34% of men.
In contrast, 21% of women were not prescribed any of the four, compared with 10% of men.
According to Australian Institute of Health and Welfare figures for 2015, CHD is a leading cause of death among women, with women accounting for 44% of deaths from CHD.
Globally, CHD is now the leading cause of death, with an estimated 3.4 million women dying from the disease each year.
Julie Anne Mitchell from Australia’s National Heart Foundation says research consistently highlights that women are “invisible when it comes to heart disease”.
“Heart health checks, lifestyle changes and appropriate medications are just as important for women as they are for men, and these findings challenge all clinicians to keep this in mind when assessing patients,” she says.
“Australian research highlights that total healthcare spending on women with heart disease is less than half of that spent on men, and this latest research shows yet again why we need to redress the imbalance.”
The American Heart Association reports that certain risk factors for CHD increase around the time of menopause, potentially due to the decline in the hormone Estrogen which relaxes the internal artery wall.
However, cardiologist Nieca Goldberg does point out that “estrogen decline isn’t the only reason women face a higher cardiovascular disease risk after reaching menopause”.
“We’re trying to figure the rest of it out,” she says.
Amelia Nichele is a science journalist at The Royal Institution of Australia.
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