Spokane Journal of Business

Women less likely to get heart drugs

Study finds lower usage of aspirin, beta-blockers, statins, ACE inhibitors

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Women and men experience a similar prevalence of adverse drug reactions in the treatment of coronary-artery disease. Women, though, are significantly less likely than their male counterparts to be treated with statins, aspirin, and beta-blockers, according to a new study by researchers at Rush University Medical Center, in Chicago.

The study was published in this months issue of a journal called Gender Medicine.

Developments in disease recognition and novel treatment strategies have led to a significant decline in overall cardiovascular death rate among men, but these dramatic improvements have not been observed in women, says Dr. Jonathan R. Enriquez, lead author of the study and a resident internal medicine physician at Rush. This may be related to underutilization of medical therapies such as aspirin, beta-blockers, ACE (angiotensin-converting-enzyme) inhibitors, or statins.

In association with Dr. Annabelle Volgman and the Rush Heart Center for Women, the study involved 304 consecutive patients with coronary-artery disease at the outpatient cardiology clinic at Rush. An analysis was performed to determine the usage and adverse reactions reported from aspirin, beta-blockers, ACE inhibitors, and statins. Baseline clinical characteristics also were determined to identify the independent association of gender on usage of standard medical coronary-artery disease treatments.

Statins are a class of drugs used commonly to lower cholesterol, and beta-blockers are a class of heart drugs used typically to decrease the amount of work the heart must do by slowing the heart rate and lowering blood pressure. ACE inhibitors, similarly, are a group of medications that help relax blood vessels and are used to treat high blood pressure and other conditions.

The study found that only 78.1 percent of women were treated with statins, compared with 90.8 percent of men. After adjustment for clinical characteristics, men were also found to be six times more likely to receive aspirin and beta-blockers. No significant difference was noted between genders in the prevalence of adverse drug reactions.

The physicians perception of either anticipated adverse drug reactions or less severe disease may be influencing their decision to not prescribe these medications for women, says Enriquez. We encourage further studies to identify the cause of this disparity, so that care for women with coronary-artery disease may be optimized.

Coronary-artery disease is the leading-cause of death among women in the U.S., and annually since 1984 the number of cardiovascular-related deaths in women has exceeded that of men. Women may suffer not only from decreased survival with coronary-artery disease, but also may experience a worse quality of life than men.

Given the findings of this study and other studies documenting the underutilization of current medical therapies in women, we must consider potential solutions to improve care of all patients during the outpatient visit, says Enriquez.

At the Rush Heart Center for Women, women with heart problems are diagnosed and treated by a team of cardiologists, nurse practitioners, nurses, nutritionists, and cardiothoracic surgeons. Women without overt heart disease are assessed and advised on how to prevent heart disease and stroke.

Rush University Medical Center is an academic medical center that encompasses the more than 600-bed hospital (including Rush Childrens Hospital), the Johnston R. Bowman Health Center, and Rush University. Rush University, with more than 1,270 students, is home to one of the first medical schools in the Midwest and a highly ranked nursing college. The university also offers graduate programs in allied health and the basic sciences. Rush seeks to bring together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders, and diseases associated with aging.

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