Noel Bairey Merz, Professor of Medicine & Director of the Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, USA, speaks to Cardio Debate about cardiovascular disease in young women and whether we are winning the “war”.
What are the main issues you discussed in your lecture regarding Heart Disease prevention in young women?
We are not winning the war. In relatively young women under the age of 50, and particularly 35 to 45, women’s heart disease mortality is actually on the rise compared to declines in older women, older men and younger men.
Then we talked about reasons for this, and it is quite evident that both in secondary prevention of heart disease as well as primary prevention women are often not recognised, not evaluated and even when they are evaluated and identified as being at risk and eligible for treatment, they are often not treated.
We talked about issues of gender in society, gender in medicine where women are viewed more as objects, women are more likely to be told to lose weight if they are diabetic than actually be prescribed a statin, which is in the guidelines.
Women with acute coronary syndromes, up to 40% do not have obstructive coronary disease and they are not treated despite guidelines stating that they should be treated and evidence base strongly suggesting that the treatment as effective.
So we can conclude that all healthcare providers should look at their own practice. If they question whether or not they live in a gendered society they should take the implicit biased test from Harvard University, it’s available on Google free of charge. https://implicit.harvard.edu/implicit/takeatest.html
Basically, what we find is everyone has some gender biases, including healthcare providers and cardiologists, and that we need to go back to clinic and do a better job. And risk assess and treat women when they should be treated.