April 27, 2017 | Sanah Christopher, MD
Career Development

“So, does this mean I can have a heart attack too?” my patient’s wife asks, genuinely concerned about her own cardiovascular health, just as I finished discussing the lifestyle and co-morbid factors that had placed my new patient at risk for his recent ST-segment elevation myocardial infarction (STEMI). Such a scenario is not entirely uncommon with female patients who become cognizant of their own cardiovascular risk after personally experiencing an adverse cardiac event, or having supported a family member through one. It is a well known fact that the diagnosis of coronary artery disease is often delayed in women. Furthermore, heart disease is noted to be the leading cause of death in older women and the third most common cause of death in women globally. Fortunately, initiatives to improve the diagnosis and management of coronary artery disease in women are bringing increased awareness to the cause. As FITs and future cardiologists, integrating practices for early recognition and management of women’s cardiovascular health can help further this cause at a grassroots level. Here are a few suggestions for doing so early in our medical careers:

• Become familiar with current and emerging literature on cardiovascular risks and outcomes in women – Female representation in clinical trials has been fairly low and many gaps still exist in our current knowledge of women’s cardiovascular health. The ACC has emphasized the need for more focused cardiovascular research on women, and more evidence is emerging regarding the underlying differences in the overall risk profile, clinical presentation and methods to reduce mortality outcomes in this demographic. As clinicians, expanding our knowledge base with current and developing literature for women’s health during fellowship training, and during the subsequent stages of our career, can truly advance our clinical practice.

• Encourage early prevention – The past few decades have seen a distinct rise in primary prevention measures secondary to public health initiatives. Mammograms, colonoscopies and other primary prevention measures are frequently incorporated into routine health work up for female patients. An equally strong emphasis is now being placed on smoking cessation, dietary and lifestyle modifications to improve cardiovascular risks and overall mortality. Encouraging more providers and personally incorporating the emphasis on such modifications into routine health appointments can lead to improvement of outcomes for our female patients.

• Identification of atypical signs and symptoms – Current evidence suggests that women are less likely to experience or report chest pain or discomfort with acute coronary syndrome. Education for patients and providers regarding atypical presentations, both in inpatient, and in primary care settings, can facilitate early diagnosis of ischemia. Additionally, it can significantly reduce times taken by patients prior to seeking medical attention and subsequent treatment.

• Attending local initiatives and events to support women’s health – While I encourage both male and female colleagues to engage with promoting the cause, as female FITs, we can add a more personal perspective to women’s cardiovascular health. Attending seminars and meetings can additionally help network and develop relationships with local and global organizations that promote women’s health at many different levels. Encouraging and educating family, friends and co-workers is another way to bring forth the emphasis on cardiovascular health on a more individual level. 

The paradigm of coronary artery disease as a ‘man’s disease’ no longer holds true in current medical practice. As the future generation of cardiologists, we can integrate, and consistently improve on current models for improvement of women’s health through a multitude of measures. Incorporating these measures early during training as FITs can definitely set the basis for further advancement for the cause in clinical practice. 

This article was authored by Sanah Christopher, MD, a Fellow in Training (FIT) at Virginia Commonwealth University Health System.