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Cardiovascular Report - Homing In on a Woman's Heart

Cardiovascular Report Winter 2010

Homing In on a Woman's Heart

Date: February 28, 2010


Pamela Ouyang and Nisha Chandra-Strobos say that in women, heart disease is still under-recognized.
Pamela Ouyang and Nisha Chandra-Strobos say that in women, heart disease is still under-recognized.

It’s a staple of romantic comedies that in matters of the heart, women differ from men. In the treatment and diagnosis of cardiovascular disease, however, that has not been the case.

For the most part, women’s and men’s hearts have been treated the same way, largely because the most commonly used measures of risk and methods of treatment are derived primarily from research on male patients. The results of these studies have been assumed to apply equally to women, but accruing evidence shows that men’s and women’s hearts may not be nearly as alike as previously thought.

In fact, convinced not only by their own research but by their clinical experience as well, Nisha Chandra-Strobos, chief of cardiology at Johns Hopkins Bayview Medical Center, and her colleague Pamela Ouyang felt compelled two years ago to launch a women’s heart program within their clinic. Today, their undertaking has evolved into the Women’s Cardiovascular Health Center, which Ouyang directs.

The need is critical, says Chandra-Strobos, because heart disease is the leading cause of death in women, in part because symptoms are under-recognized.

Recent studies have begun to demonstrate that women’s heart problems may not present in the same way that men’s do and also that heart disease has a different trajectory in women. Though men typically present with heart problems about a decade earlier in life than women, Ouyang and Chandra-Strobos are seeing more women with heart problems in their 40s, and some of their patients are even in their 20s.

The most important difference between treating men and women heart patients, says Ouyang, director of the center, is the greater difficultly in determining if a woman is at risk in the first place. Commonly used measures such as the Framingham Risk Score may not be as able to capture an accurate picture of risk in women.

For instance, many women under 65 who present with a myocardial infarction, if assessed the day before the heart attack, would likely qualify as low risk because the traditional risk assessment scores do not take into account factors such as  stress and depression, presence of rheumatologic disease and presence of metabolic syndrome that may constitute higher risk in women than in men.

And there are risk factors specific to women, says Ouyang, such as pregnancy-associated diabetes and hypertension and elevated levels of testosterone before menopause.

Besides being informed by the research Chandra-Strobos, Ouyang and their colleagues are conducting (Chandra-Strobos’ research explores how women with heart disease are receiving care; Ouyang is focusing on sex differences in cardiovascular risk and disease), the Women’s Cardiovascular Health Center provides comprehensive evaluations that include not only a cardiologist but also a nutritionist and psychologist.

“We want women to understand that they’re at risk,” says Ouyang. “We’re looking at women’s heart health from all aspects—young and old, pregnant women and perimenopausal women.”

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