A Specialist’s Perspective on Cardiovascular Disease in Women: C Noel Bairey Merz, MD

Introduction

C Noel Bairey Merz, MD, is the director of the Barbra Streisand Women’s Heart Center and the Linda Joy Pollin Women’s Heart Health Program at the Cedars-Sinai Heart Institute in Los Angeles, California, where she also serves as a professor of medicine. Her research focuses on heart disease in women, preventive cardiology, coronary physiology/pathophysiology, advanced cardiac imaging, and alternative/complementary medicine approaches.

Recently, Dr Bairey Merz headed an investigation on heart health campaigns for women. She and her colleagues at the Women’s Heart Alliance (WHA) surveyed more than 1000 women (aged 25 to 60 years) and found that 45% are not aware that heart disease is the leading cause of death for women in the United States. Her colleague, Holly S Andersen, MD, of New York-Presbyterian Hospital, Weill Cornell Medical Center, presented their findings at the American Heart Association Scientific Sessions in Orlando in November.

While attending the Scientific Sessions, Dr Bairey Merz discussed the current state and the future of women’s cardiovascular care with Cardiology Advisor. 

Q: Are there any current campaigns that do a good job making heart disease “real” for women?

WomenHeart, National Heart Lung and Blood Institute (NHLBI), and American Heart Association (AHA) campaigns were effective at raising community awareness. (WomenHeart is a survivor’s network that seeks to improve treatment of women with existing heart disease.) The level of awareness went from 15% to 50%, so while those campaigns clearly weren’t unsuccessful, it has been stuck for the last 10 years or so.^1-4

As of late, there haven’t been any other cardiovascular campaigns as effective as WomenHeart, NHLBI Heart Truth, or AHA’s Go Red For Women.

But one of the Women’s Heart Alliance’s (WHA) concerns is that there isn’t enough focus on sex differences, so women and clinicians continue to miss things. Women and men are different. Maybe they should be treated differently.

For example about 50% of women will present with the same symptoms as men during a heart attack, the main one of which is chest pain.⁵ But research clearly shows the other 50% have a wide variety of atypical symptoms – indigestion, upset stomach, cold sweats, clamminess, shortness of breath, etc. And they’re more likely to have shoulder, arm, tooth, or jaw pain instead of chest pain. ⁵

I tell a woman who presents with atypical symptoms and has already had a heart attack to tell the emergency department she’s having chest pain even if she’s not because otherwise they may misdiagnose you. I’ve had patients get their gallbladders removed instead of being treated for a heart attack.

Research is now focusing on female-pattern angina.⁶ And in the end, female-specific research will help both women and men, and care will become personalized.