Doctors recommended that their female patients improve their lifestyle to prevent heart disease while men were more often advised to take statins, according to an analysis presented last month at ESC Asia, a medical congress organized by the European Society of Cardiology (ESC), the Asian Pacific Society of Cardiology (APSC), and the ASEAN Federation of Cardiology (AFC).

The study, conducted by researchers from Harvard Medical School and Massachusetts General Hospital, Boston, used data from the US National Health and Nutrition Examination Survey (NHANES) in the 3-year period from 2017 to 2020.  The researchers examined the advice that nearly 3,000 high-risk men and women received for prevention of heart disease and found that, although guidelines for heart disease prevention are gender neutral, in practice, doctors advise less interventional strategies for women.

Data on differences

The premise of their investigation stemmed from prior studies which revealed that women diagnosed with cardiovascular disease receive less aggressive treatment compared to men.  In this study, the team set out to explore whether these sex differences extended to advice on prevention of cardiovascular disease as well—even though guideline recommendations to prevent heart disease are the same for men and women.

The study included more than 8,500 men and women between 40 and 79 years of age with no history of heart disease.  Of the 8,512 participants, 2,924 were found to be at increased risk for developing cardiovascular disease according to a validated risk calculator and were therefore eligible to receive statins.

For those 2,924 participants, the researchers calculated the odds of men, compared with women, being prescribed statin therapy, and receiving advice to lose weight, exercise, reduce salt intake, and reduce fat or calorie consumption.  The analysis was adjusted for age, risk of cardiovascular disease, body mass index, resting heart rate, depression score, and education status.

Doctors’ advice and actions:  male vs female

The study demonstrated that, although both at-risk men and women were eligible to be administered statins, men were 20% more likely than women to actually be prescribed the lipid-lowering medications.  In contrast, women were almost 40% more likely than men to receive recommendations for behavioral modifications such as losing weight, exercising more, and smoking cessation.

Among the key research findings were that women were 27% more likely than men to be advised to lose weight or reduce their salt intake, 38% more likely than men to receive recommendations to exercise, and 11% more likely than men to be advised to reduce their fat or calorie consumption.

Why the discrepancy?

As to why the prevention of heart disease in women appeared sub-optimal, according to the study, the reasons vary.  One possible explanation, according to the researchers, is that heart disease may still be perceived by healthcare providers as an illness that predominantly impacts men, despite statistics showing women are also greatly affected.

Another potential contributor to the treatment bias is that women continue to be underrepresented in research studies which may lead to practitioners being cautious about managing heart disease the same in both men and women.  Finally, women themselves may also be part of the puzzle.  Despite increases in awareness over the past decades, CDC data shows that only about half (56%) of women recognize that heart disease is their number 1 killer.  Data has also shown that women more often prefer lifestyle intervention over medications in other chronic health care condition treatment.

Study author Prima Hapsari Wulandari, MD, a cardiology clinical researcher at Massachusetts General Hospital in Boston, posited that “a potential root of the discrepancy in advice is the misconception that women have a lower risk of cardiovascular disease than men.”

1 in 5 female fatalities

Despite American Heart Association data showing that approximately 80% of heart disease can be prevented, nearly 700,000 people die of heart disease in the US every year making it the most common cause of death, according to the Centers for Disease Control and Prevention (CDC).  Among women, heart disease causes 1 in 5 deaths, and ~1 in 16 women over 20 years of age have coronary heart disease, the most common type of heart disease, per CDC statistics.

In health care overall, multiple studies have shown that inherent biases among doctors lead to women not being diagnosed or experiencing a delay in receiving a diagnosis.

“Our study found that women are advised to lose weight, exercise and improve their diet to avoid cardiovascular disease, but men are prescribed lipid-lowering medication,” Dr. Wulandari said in the study findings.  “This is despite the fact that guideline recommendations to prevent heart disease are the same for men and women.”

“Our findings highlight the need for greater awareness among health professionals to ensure that both women and men receive the most up-to-date information on how to maintain heart health,” she emphasized in an ESC news release which accompanied the conference presentation.

Clinicians’ Bonus:  More To Know

Resources for you and your patients

 For You

The WISEWOMAN (Well-Integrated Screening and Evaluation for WOMen Across the Nation) program was created to help women understand and reduce their risk for heart disease and stroke by providing services to promote lasting heart-healthy lifestyles.  Working with low-income, uninsured, and underinsured women aged 40 to 64 years, the program provides heart disease and stroke risk factor screenings and services that promote healthy behaviors.  The WISEWOMAN program is administered through CDC’s Division for Heart Disease and Stroke Prevention.  Find particulars here.

 For Your Patients

CDC’s Heart Disease Home houses step-by-step patient information that shows them how, by living a healthy lifestyle, they can help keep blood pressure, cholesterol, and blood sugar levels normal and lower their risk for heart disease and heart attack.

The contents of this feature are not provided or reviewed by NPWH.