Serving the Underserved—Making Strides to Improve Women’s Cardiovascular Health

Dr Kevin R. Campbell, MD, FACC

Author of Women and Cardiovascular Disease: Addressing Disparities in Care
Assistant Professor of Medicine, Division of Cardiology
University of North Carolina, North Carolina, USA

At the age of four, my daughter Bek began to have troubles with fatigue. Her mother noted that she was drinking more water and seemed to have to go to the restroom more frequently than her peers. As two physician parents, we began to go through a ‘worst case scenario’ differential diagnosis. As her symptoms continued, we both became concerned that she might have diabetes—a dreaded disease without a cure. Within a few days we had her tested and were devastated to learn that she did in fact have Type 1 insulin-dependent diabetes. We were admitted to Duke Medical Center for insulin initiation and diabetes education. Our lives were forever changed.

As a cardiologist, I began to deal with the reality of my daughter’s disease—she would likely suffer coronary artery disease (CAD) and other complications during her lifetime. Personal experience in my own practice suggested it very clearly; many of the patients with premature CAD that I cared for daily in my clinic were women with life-long diabetes. Based on data from the American Heart Association, published in the early 2000s, when she was diagnosed, I knew that women with CAD were less likely to receive prompt diagnosis and treatment for heart disease (HD) at early stages. Moreover, the data suggested that women were (and still are) often treated less aggressively than men and were less likely to receive timely treatment with advanced procedures. At that moment, I made it my mission to improve the care of women with HD through education, awareness, research, and advocacy. As I looked at ways to impact our healthcare system and change the ways in which women with HD were treated, I decided to write a book on gender disparities in the treatment of cardiovascular disease. This project—inspired by my daughter—has now come to completion with the publication of my new book Women and Cardiovascular Disease: Addressing Disparities in Care.

As I researched my book and began to write, many absolute truths began to take shape. It became clear that changes must be made in order to improve cardiac care for women throughout the world. Most importantly, I found that more women than men die each year from HD in the USA and the UK. In the USA, as well as in the UK (and throughout Europe), women are less likely to receive advanced therapies for similar cardiovascular illnesses than men.

But What Can Be Done?

In order to effect change and close the gender gap in cardiovascular care, we must understand the root causes. There are many factors that may help to explain these inconsistencies:

  1. Societal Norms/Awareness: HD is thought to be a disease of men. In general, most women do not even realise that they are at risk. While recent awareness campaigns have significantly increased knowledge of HD in women, there are still very large gaps, particularly among minorities and within certain geographic regions in the USA.
  2. Patient Factors: Women often present with symptoms that are very different to men’s. Rather than crushing sub-sternal chest pain, many women may simply have feelings of anxiety or dread, flu like illness, or fatigue. Certainly this can make diagnosis more difficult. Moreover, women often put off their own healthcare and focus on the health of their spouse and children.
  3. Physician Bias: Many physicians are less aggressive in the treatment of women and much of this is due to concerns over complications. In the early coronary intervention data, there is a slightly higher rate of complications in women undergoing cardiac catheterisation. However, the best available evidence suggests that we should apply current treatment guidelines to both sexes.

Ultimately, the burden of providing excellent cardiovascular care for women falls upon both the physician and the patient. We must help female patients engage in their own healthcare, identify modifiable risk factors, and effect change. As physicians, we must redouble our efforts to ensure that women get equal care. We must interpret atypical symptoms in the setting of a risk profile and use diagnostic tests as well as interventional procedures appropriately. Moreover, we must continue to educate the community at large, increase awareness, and advocate for women throughout the world. It is my hope that my legacy will be the cardiovascular health of my daughter Bek—while diabetes remains an incurable disease, I hope that my book and those that it may inspire will be the instruments for change. Together, we can improve outcomes for women and eliminate disparities in care in the future.

Women and Cardiovascular Disease

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