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Dr. Daryl Jacobs, St. Luke's Hospital

Women less likely to get preventive treatment before first heart attack

Heart disease is the leading killer of both men and women in the United States, but new research from the Minneapolis Heart Institute indicates that women are less likely to be diagnosed with coronary artery disease (CAD) and less likely to receive preventive medications prior to their heart attacks than older men.

Coronary artery disease, also known as atherosclerosis, occurs when a waxy, cholesterol-laden substance called plaque builds up in the coronary arteries, reducing oxygen-rich blood flow to the heart muscle. This is a slow process that starts in people in their twenties. Eventually, an area of plaque can rupture (break open) inside an artery causing a blood clot to form. If it's large enough, the clot can completely block blood flow through the artery resulting in heart muscle damage.

The study evaluated more than 3,000 heart attack patients over seven years. About 70 percent of these patients did not know they had CAD, and 60 percent of those undiagnosed patients were men under 55 and women under 65 years of age. The Framingham Risk Score, the most widely used cardiac event risk calculator, is heavily weighted toward age and gender and would classify these women and younger men as lower risk patients. Therefore, these patients are much less likely to receive preventive treatment (prior to a heart attack) with aspirin or cholesterol-lowering statin drugs than older men.

In addition, rather than having typical chest pain, women often have atypical symptoms of CAD such as shortness of breath, weakness, dizziness, sweating and nausea which may cause physicians to initially pursue diagnoses other than CAD.

While older men are still the most likely group to have heart attacks, women clearly make up a substantial portion of the heart attacks diagnosed, and very few are on preventive medications prior to their first heart attack. Better methods of assessing a woman's risk would potentially allow physicians to target higher-risk women, reducing their chance of a heart attack. Risk factors for coronary artery disease include tobacco use, high blood pressure, diabetes, high cholesterol, obesity, stress, family history of CAD and age.

Dr. Daryl Jacobs is a board-certified interventional cardiologist at St. Luke's Hospital.

This article was published in the St. Louis Post-Dispatch on February 9, 2012.