Women and Cardiovascular Disease – There is A Difference Between Men and Women

Front view of woman holding seedlingThe American Society of Preventive Cardiology presented an educational seminar recently in Boca Raton, Florida to educate physicians, nurses and health care providers that cardiovascular disease in women can be very different than in men.  Failure to recognize these differences has resulted in women being under diagnosed, under treated and suffering worse outcomes.

The difference is first noticeable in pregnancy when the development of elevated blood pressure, super elevation of lipids and the development of gestational diabetes predispose young mothers to earlier, more serious, cardiovascular risk later in life. The faculty noted that women of child bearing age tend to use their obstetrician as their primary care doctor.  They suggested that women with pregnancy related diabetes, hypertension and lipid abnormalities should be referred to a medical doctor knowledgeable in preventive cardiology, post-delivery, for ongoing care.

For reasons that are unclear, women are less likely to be treated to recommended guidelines for lipids, diabetes and hypertension.  Diabetic women have a far worse prognosis with regard to cardiovascular disease as compared to men. They are less likely to be treated with aspirin, which while not as effective in preventing MI in women, is apparently protective against stroke.

Women about to have a heart attack have different symptoms the weeks, to months, before the event. They are more likely to have sleep disturbances, unexplained fatigue, weakness and shortness of breath than the standard exertional angina seen in men.   When they do have a heart attack they are as likely to have shortness of breath and upper abdominal fullness and heartburn as they are to have chest pain. They are more likely to have neck and back pain with nausea than men are.  

Since women have different symptoms than men they are more likely to be sent home from the emergency room without treatment.  They are less likely to have bypass surgery than men, less likely to be treated with the anticoagulants and antiplatelet medications that men are treated with and, they are less likely to be taken to the catheterization lab for diagnosis and intervention as compared to men.

The faculty was comprised of world-class researchers, clinicians and educators who happened to be outstanding speakers as well, bringing a vital message to our community.  They pointed out the different questions and diagnostic tests we should be considering in evaluating a woman as opposed to a man.

This was my first educational seminar through the American College of Preventive Cardiology and I thank them for the message they delivered to the medical and nursing community at probably one of the finest seminars I have had the privilege to attend.

Flu Shots Are Coming

ShotWe recently ordered our influenza prevention vaccine. The official public health kickoff to the influenza 2013 prevention campaign is September 1, but in order to have an adequate supply you have to order it long in advance. Once again the price per dose has increased. Once again we will be competing with Walgreens, and CVS and every country club association for the right to immunize you against a potential lethal but preventable disease. I would prefer that all my adult patients receive the flu shot and I do not care where you get it. Yes I would like to administer enough vaccine to cover my costs but the most important aspect of the flu shot campaign is to vaccinate as many people and protect as many patients as you can.

What’s different about the flu shot campaign this year? Jennie McCarthy, the beautiful and outspoken ex–Playboy playmate and well known almost evangelical opponent of vaccination programs, has now been given a pulpit on the television show “The View.” Her anti-vaccine opinion will certainly be heard loud and clear as the local public health departments get out the word to get your shot. There is a new egg free vaccine for adults 18- 49 years old with a history of severe allergy to eggs. Flublok or RIV3 is not grown in eggs but is made through recombinant DNA technology especially for individuals with egg allergy. I have no information on pricing or availability of the RIV3 vaccine yet but it will be administered to individuals with documented severe egg allergies not just anyone. At the current time any patients in the practice who require RIV3 or Flublok will be referred to a center that stocks it.

The other piece of new but positive news is that a study by Roger Baxter, MD of the Kaiser Permanente Vaccine Study Center in Oakland, California and published in the online version of the Journal of Clinical infectious Disease showed that there is no relationship between the administration of inactivated influenza vaccine and the development of Guillan-Barrre’ Syndrome ( GBS). The study originated after the 1976 vaccination against the Swine Flu virus was found to increase the risk of GBS. Since then in a review of 32.7 million person-years of follow-up there were 415 cases of GBS. Of those 415 incidents ONLY 25 were associated with vaccination in the previous weeks.

We urge our adult patients especially those with chronic health conditions to get flu shot this season. While you are making your plans for a flu shot make sure you are current on tetanus vaccine, shingles vaccine and pneumovax. Keep in mind our peak local flu season occurs in January and February with most adults requiring two weeks after the vaccine is administered to develop complete immunity.