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

Q: Why do you think some women’s health issues, like breast cancer, get more attention than heart disease?

I don’t know that we have the answer. Bikini medicine—medicine that focuses on reproductive organs—is still a problem. There is a tradition coming from the health care system that women’s health is defined only by their reproductive organs.

Both health care providers and women are part of the larger society that sees the world through gendered lenses. While we all have the best of intentions, it’s difficult to ignore our biases.

More recently, I think the attention comes from the types of breast cancer campaigns, such as NFL players wearing pink. Breasts and breast cancer have been sexualized. We don’t like to talk about graphic sex, but we like to have our little innuendoes.

Q: Could you suggest opportunities for improved communication among physicians (PCPs, OB/GYNs, and cardiologists)?

We have a lot of opportunities. Women rarely see cardiologists, even when they have heart attacks. If a man has a heart attack, most are seen by a cardiologist. Women are also not being seen for prevention.

OB/GYNs are surgically trained—as in, they are focused on surgical reproductive issues—and do not have the same training as general physicians when it comes to cardiovascular disease prevention such as chronic hypertension, cholesterol, and diabetes management.

Advanced practice providers (eg, nurse practitioners and physician’s assistants) are trained to follow protocol so they are proficient at chronic care management, but are unfortunately not typically present in OB/GYN offices. One potential solution would be to have NPs and PAs available right in the offices.

Q: What has changed in your own practice as a result of the WHA survey?

For many years, we did not routinely weigh women in my practice. We asked about their diet and exercise, but we did not weigh them unless they asked to be weighed.

But now, due to electronic health records and new technology, including patient exam tables and chairs equipped with scales, a patient is weighed regardless of whether or not they want to be.

References

1. Mosca L, Hammond G, Mochari-Greenberger H, et al; on behalf of the American Heart Association Cardiovascular Disease and Stroke in Women and Special Populations Committee of the Council on Clinical Cardiology, Council, on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on High Blood Pressure Research, and Council on Nutrition, Physical Activity, and Metabolism. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association National Survey. Circulation.2013;127(11):1254-1263. doi: 10.1161/CIR.0b013e318287cf2f. 
2. Mosca L, Jones WK, King KB, Ouyang P, Redberg RF, Hill MN. Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American heart Assocation Women’s Heart Disease and Stroke Campaign Task Force. Arch Fam Med. 2000;9(6):506-515.
3. Andersen H. LBCT.01 – Failure Is Not an Option: New Drugs and Systems of Care. The No. 1 Killer Is Invisible to Most Women. Presented at the American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.
4. Johnson P, Bairey Merz NC, Andersen H, et al. Abstract 14230. Women Speak Up About Personalized Heart Health Awareness: A Women’s Heart Alliance Research Report. Presented at the American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.
5. American Heart Association. Heart Attack Symptoms in Women. http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp#.VmHSw9UrJaQ. Accessed December 4, 2015.
6. Bairey Merz CN, Handberg EM, Shufelt CL, et al. A randomized, placebo-controlled trial of late Na current inhibition (ranolazine) in coronary microvascular dysfunction (CMD): impact on angina and myocardial perfusion reserve. Eur Heart J. 2015. doi:10.1093/eurheartj/ehv647.
7. American Heart Association. My Life Check – Life’s Simply 7. Updated November 23, 2015. http://www.heart.org/HEARTORG/Conditions/My-Life-Check—Lifes-Simple-7_UCM_471453_Article.jsp#.VmHQK9UrJaQ. Accessed December 4, 2015.
8. Atherosclerotic Cardiovascular Disease Risk Score. American College of Cardiology. http://tools.acc.org/ASCVD-Risk-Estimator/. Accessed December 4, 2015.
9. European Society of Cardiology. SCORE Risk Charts. The European cardiovascular disease risk assessment model. http://www.escardio.org/Guidelines-&-Education/Practice-tools/CVD-prevention-toolbox/SCORE-Risk-Charts. Accessed December 4, 2015.
10. Reynolds Risk Score. Calculating heart and stroke risk for women and men. http://www.reynoldsriskscore.org/. Accessed December 4, 2015.
11. Liefheit-Limson EC, D’Onofrio G, Daneshvar M, et al. Sex differences in cardiac risk factors, perceived risk, and health care provider discussion of risk and risk modification among young patients with acute myocardial infarction: the VIRGO study. J Am Coll Cardiol. 2015;66(18):1949-1957. doi: http://dx.doi.org/10.1016.j.jacc.2015.08.859.
12. Dreyer RP, Smolderen KG, Strait KM, et al. Gender differences in pre-event health status of young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardivasc Care. 2015. doi:10.1177/2048872615568967.