Women & Cardiovascular Disease

May 11, 2020

With the constant stream of pandemic information coming at us, it was refreshing to attempt a pause of sorts, in whatever way we could, to celebrate Mother's Day on Sunday, May 10th.

May 10th also marked the beginning of National Women’s Health Week in the United States. This week-long health observance is a reminder for us to make women’s health a priority. Underlying conditions, including cardiovascular disease, are specific areas of focus given the increased risks they bring to women.

It is well understood that our usual care pathway for diagnosing heart disease does not serve women well. The American Heart Association reports that “64% of women who die suddenly of coronary heart disease reported no previous symptoms.” And when women do report symptoms, the data shows that, compared to men, women have:

  • 4 times as many false positives from stress testing1,2
  • 50% higher likelihood to undergo an invasive angiogram finding no obstructive disease3
  • 20% higher likelihood of cardiac or all-cause death at 5 years following PCI4

However, not all news on this front is discouraging! Global clinical data are showing that clinical practice can better serve women through the increased use of coronary CTA and improved communication with patients.

Data from ISCHEMIA, SCOT-HEART, CRESCENT, and ROMICAT II all show that CTA can help to reduce the guesswork in cardiac care for women by:

  • Identifying the false positives that women experience from stress testing
  • Providing a shorter timeline to a definitive diagnosis
  • Increasing resolution of chest pain at 1-year

Additionally, ISCHEMIA data presented at ACC 2020 showed that women experience more frequent chest pain without classically defined obstructive disease. This data, combined with the report from the AHA about a lack of symptoms in women, might provide an opportunity to reframe what clinicians and patients identify as “symptoms”. Instead of focusing on the “classic” image of someone clutching their chest in pain, we need to pay attention to the unique symptoms women are likely to experience such as arm or jaw discomfort, fatigue, nausea and indigestion.

Global healthcare is transitioning right now before our eyes.  It is clear that today’s decisions will influence the care that patients receive for years to come. As healthcare leaders such as the European Society of Cardiology and major US insurers such as UnitedHealthcare choose to prioritize coronary CTA for patients, they are defining a better care future.

So this Women’s Health Week, let’s commit to a better diagnostic pathway for women and others who have been underserved by offerings of the past. Change like this moves us all forward together.

— A perspective from HeartFlow Chief Medical Officer, Campbell Rogers, MD
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1. Mangion, et al. Eur Heart J 2020. doi: 10.1093/eurheartj/ehz903
2. Shaw, et al. J Am Coll Cardiol 2006. doi: 10.1016/j.jacc.2005.01.072
3. Shaw, et al. Circulation 2008. doi: 10.1161/circulationaha.107.726562
4. Kosmidou, et al. J Am Coll Cardiol 2020. doi: 10.1016/j.jacc.2020.01.056

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