Are Women Tougher When It Comes to Heart Disease?

Women with heart problems may be "tougher" about their disease than their male counterparts, a new University of Michigan study suggests. And that difference may help explain why they're less likely to get aggressive care for the No. 1 killer of both women and men.

In a study published in the most recent issue of the American Journal of Medicine, researchers from the U-M College of Pharmacy and the U-M Cardiovascular Center report the results of an exhaustive survey of 490 heart patients treated at U-M for a heart attack or severe chest pain who were enrolled in a research registry.

In all, the 142 women and 348 men rated the severity of their heart disease about the same. But in fact, the women had much worse disease, took many more medicines, and experienced more serious symptoms and limitations on their daily lives, according to their medical records and answers on standardized questionnaires.

In other words, the women who had major problems related to their heart disease were just as likely to rate their disease as "mild to moderate" as men with far less-severe problems. And when the researchers took into account the differences between patients, the men were significantly more likely than women with similar disease levels to perceive their disease as severe.

"It's important to understand women's perceptions, beliefs and attitudes about cardiac disease and its treatment," says senior author Steven Erickson, Pharm.D., an associate professor of clinical sciences in the College of Pharmacy and a clinical pharmacist at the U-M Health System. "If women do not perceive their cardiac disease as severe, they may not pursue medical evaluation, treatment or rehabilitation."

Indeed, previous studies by other researchers have shown that women heart-attack survivors, for example, are less likely to go for post-heart attack rehab programs involving exercise and education to help patients improve their health. Women are also more likely to delay seeking help for heart-related symptoms than men, and are less likely to receive heart-related diagnostic and therapeutic procedures.

The root cause of these gender differences has puzzled researchers for years, says co-author Kim A. Eagle, M.D., FACC, clinical director of the U-M CVC and the Hewlett Professor of Internal Medicine at the U-M Medical School.

"Physician bias and lack of awareness have been leading suspects, but no one has examined differences in attitudes," he says. "Although our study cannot prove that women's 'toughness' influences their tendency to seek and accept aggressive care for their heart problems, we hope it prompts further investigation of this question."

The study, published in the November issue of AJM, is based on data from the U-M CVC's Acute Coronary Syndrome/Myocardial Infarction Patient Registry, which includes thousands of U-M heart attack and angina patients.