No Help for Women with Congestive Heart FailureMost studies of cardiovascular disease and its manifestations have been done in men. That's an undisputed truth. In view of this fact, much of the clinical management of heart disease in women is extrapolated from data gleaned studying men. Unfortunately, just like calculating medicine dosages for children based on studies in adults, it doesn't work. Children are not little adults, and women are not men with different anatomy.
The latest study to bear this out is Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure in the current issue of Archives of Internal Medicine. This meta-analysis, where data from a multitude of studies is pooled and analyzed together, looked at the impact of implanting an automatic defibrillator, a device designed to monitor the heart and shock it back into a normal rhythm when it isn't working right, in women with congestive heart failure.
The study found that not only wasn't the defibrillator helpful in these women, the very act of implanting it was associated with a higher rate of complications. The authors offer a number of speculations on why the device doesn't help women with congestive heart failure since it so demonstrably does help prevent sudden cardiac death in men. Some of the factors they mentioned include more advanced heart failure among women in the study, higher blood pressure and a higher rate of diabetes.
Rick and I agree that the take home message from the study is clear: heart disease and it's complications are very different between men and women. We've seen this in the past with the Framingham Heart Study, where risk factors for heart disease identified in men haven't turned out to compute a complete picture for women. We also know that many women present with different symptoms than men when they are experiencing a heart attack: men may feel classic symptoms like pain radiating down the left arm and neck or a crushing sensation in the chest, but women may only identify a vague feeling of dread or a sensation they think may be indigestion.
What does this mean for women at high risk for cardiovascular disease or those who already have congestive heart failure? It means women and their families must advocate for themselves when it comes to management of their condition and stay abreast of new research related specifically to women. Rick also makes the plea that more women agree to participate in clinical trials, as only 18% of the study subjects in these studies cited in the meta-analysis were women.
Other topics for this week included Small-Intestinal Histopathology and Mortality Risk in Celiac Disease in JAMA, and Dabigatran versus Warfarin in Patients with Atrial Fibrillation and Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma and Treatment of Medulloblastoma with Hedgehog Pathway Inhibitor GDC-0449 in NEJM. Until next week, y'all live well.
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