Women Less Likely to Get Standard Heart Medications
It's a myth that heart attacks are a "man's disease." Yet a new research review confirms that women remain less likely than men to get medications routinely recommended for preventing heart trouble and strokes.
Researchers found that across 43 international studies, a general pattern emerged: Women with risk factors for heart disease and stroke were less likely than men to be prescribed low-dose aspirin, cholesterol-lowering statins or certain blood pressure medications.
The obvious question is why? But it cannot be definitively answered, said study leader Sanne Peters, a research fellow at the University of Oxford, in the U.K.
The discrepancy was not explained by age, she said, referring to the fact that men tend to develop heart disease earlier in life than women do.
But many of the studies did not fully account for health-related differences between male and female patients, according to Peters. So it's hard to know whether those factors would help explain the difference in medication prescriptions, she said.
And men were often failing to receive recommended treatments, too, Peters pointed out.
"What is worrisome," she said, "is that a substantial proportion of both women and men did not receive guideline-recommended, potentially life-saving medications."
As for the gender gap, it is a phenomenon seen in hospital care. Studies have found that when women are discharged from the hospital after treatment for a heart attack, they are less likely than men to be armed with prescriptions for certain drugs, like statins.
The new findings confirm the same pattern holds true in primary care, Peters said.
The analysis focused on 43 studies from the United States, Canada, Australia and Europe. Each had information on medication prescriptions to patients with either established heart disease, a history of stroke, or risk factors for those conditions.
Overall, women were 19% less likely to be on low-dose aspirin, and 10% less likely to have a statin prescription. When it came to blood pressure drugs, they were 15% less likely to be on an ACE inhibitor. In contrast, women were more likely than men to be on a diuretic -- by 27%.
The researchers note that heart disease is the leading cause of death in the world. Their new findings were published May 20 in the Journal of the American Heart Association.
There could be a number of reasons women had lower rates of certain prescriptions, said Dr. Gina Lundberg, clinical director of Emory Women's Heart Center, in Atlanta.
In general, women in their 50s are often "incorrectly perceived to be at lower risk of heart disease, which contributes to their under-treatment," said Lundberg, who is also a volunteer with the American Heart Association.
Meanwhile, she added, older women are commonly seen as "fragile," which can affect their treatment. They may not get low-dose aspirin, for example, because doctors think they have too high a risk of bleeding as a side effect.
Lundberg pointed to another factor: Some women continue to see an obstetrician/gynecologist as their primary care provider, well into their 50s. "Many of these physicians are still focused on reproductive health, and not overall cardiovascular health," Lundberg said.
She stressed that women "need to be sure they're getting comprehensive health care after the child-bearing years." That includes routine measurements of blood pressure, cholesterol and blood sugar, she said.
Those screenings are recommended for women and men alike. The review found that many patients, regardless of sex, were not getting standard medications for people at heightened risk of heart trouble.
Blood pressure drugs were the most often prescribed medication, with just under 70% of men and women taking one. Fewer people were on statins. And with low-dose aspirin, only 41% of women had a prescription, versus 56% of men.
"A substantial number of people who survived a heart attack, or are at high risk of a first heart attack, do not receive the recommended treatment," Peters said.
People who fall into those groups, she said, should talk to their doctor about the benefits and risks of using heart medications.
The American Heart Association has more on heart disease in women.
SOURCES: Sanne Peters, Ph.D., research fellow, George Institute for Global Health, University of Oxford, U.K.; Gina Lundberg, M.D., clinical director, Emory Women's Heart Center, and associate professor, medicine, Emory University School of Medicine, Atlanta; May 20, 2020, Journal of the American Heart Association, online