This article may get me thrown out of the next medical association ball, which is not such a bad thing I guess, because I never actually attend those events. But, I have to say it, when it comes to preventing and treating heart disease in women, doctors are doing a pretty poor job.
That's a story in itself, but it may also very well be that men, too, are simply not getting the heart disease treatment they need, and that simply magnifies the problem.
This news that heart disease treatment in women is just not up to par comes to us courtesy of an update of the HERS study, which was originally designed to assess the benefits that hormone replacement therapy (HRT) might offer women with established heart disease. You remember, of course, that so much was made by so many experts of the ability of HRT to prevent and perhaps even treat heart disease, and who better to obtain that benefit than women who already have heart disease. So several thousand postmenopausal women with established heart disease (average age of 67) were enrolled in this major study, and the results rocked the medical world because the HERS was the first study to show conclusively that HRT didn't help these women at all. In fact, it killed more women than it helped.
That was then. This is now. Researchers went back to take a look at the women in the HERS study to see what else they could determine about them. Now bear in mind that these were women known to have heart disease, meaning they had either had a heart attack or they had angina, or they'd undergone a coronary bypass procedure or an angiography. Sick puppies, in other words, and women who clearly should have been receiving special care to make sure they didn't suffer another coronary event (such as heart attack) that would put a premature end to their sojourn among us.
What surprised the researchers, though, and what should shock the rest of us, is that these women were receiving anything but the most advanced cardiac care.
Starting with the good news, about 80% were on aspirin, which has clearly been shown to be beneficial in lowering the risk of further cardiac events in a population with established heart disease. The flip side of that number, though, is that 20% of these women were not taking aspirin, and that's not good.
Only about 50% of the women with elevated cholesterol levels were getting cholesterol-lowering medications, even though there is excellent evidence that people at high risk of heart attack and stroke benefit from taking medications to lower their cholesterol levels, even if they have cholesterol levels in the normal range, that is, these people are at such risk from the cardiac damage attributed to cholesterol that they need top take drugs to lower their cholesterol levels even if those levels are not high. So if their cholesterol level is high to begin with, that's a strong marker for them to take medication for that problem.
And it goes on and on. Only about a third of these women were getting a class of medications known as beta-blockers, even though most of these women should have been on those medications, and only a small minority of women were getting another class of very helpful medications known as ACE inhibitors, etc.
So, women are not getting the help they need in treating heart disease. But, although these researchers don't comment on it, other studies have shown that women also don't get the help at preventing heart disease, either.
Who's to blame for this mess? Well, treatment of any condition requires 2 partners: the treater, so to speak, and the treatee, in other words, the doctor who dispenses the medication and advice, and the patient who needs to take the medication as prescribed.
These researchers were reluctant to pin the blame on either party, the physicians or the patients, but hey, I'm not as shy as those guys.
So let me say that while it is true that patients often don't take their medications as prescribed, that's not necessarily the patient's fault. Studies tell us that many people discontinue their medications simply because they don't understand why they're on them or how important the medications are to them. In other words, their physician has simply not spent the time (and it's often a lot of time) needed to reassure the patient about those meds.
I am certain that if every doctor took enough time to patiently explain why a particular medication might substantially improve their chances of sticking around long enough to attend their grandchild's wedding, nearly everyone would stick to their prescribed regimen.
Be that as it may, this study is strong proof that all women with any risk of heart disease, meaning all women, of course, should clearly not simply rely on their doctors to get them the therapies they need. They must inform themselves of their options and then press their physicians to make sure they're getting what they need.
And you know what? Same thing is true for guys, too.