Yet many studies have tended to ignore women. Antonio Abbate, assistant professor of medicine (Virginia Commonwealth University, US), says: “As most of the original studies tended to include more men, this generated the idea that women were less likely to be affected and because they presented differently from men were labelled as ‘atypical presentation’.”
This has prompted concerns that women are treated less optimally – diagnosed later, misdiagnosed or not treated as aggressively as men.
More favourable in women...
“Nevertheless after an injury, the remodelling occurring in the heart tends to be more favourable in women than in men. This may explain the lower incidence of heart failure and ensuing mortality,” he adds.
But some can have a worse outcome, notes Vera Regitz-Zagrosek, speaker for the Center for Gender in Medicine (Charité-Universitymedicine, Germany). Mortality from myocardial infarction and post-operatively following coronary artery bypass grafting is greatest in younger women. Unknown genetic and clinical risk factors may contribute (Nature Reviews Drug Discovery 2006; doi:10.1038/nrd2032).
Gender-specific strategies
“I believe clinicians will adopt gender-specific strategies as it becomes clearer that dosing has to be different for many drugs for women and men. Knowledge on these issues will spread and physicians will take it into consideration,” she says.
Even with a gender-specific condition such as pregnancy, clinicians can miss associated heart disease. This is the case with peri and postpartum cardiomyopathy where death rates are high, despite optimal medical treatment (Circulation 2005; 111:2050-5).
“These patients are seen primarily by gynaecologists who are not so familiar with cardiac disorders and there seems to be a trend for just ignoring the disease,” says Denise Hilfiker-Kleiner, a researcher in molecular cardiology (Medizinische Hochschule, Germany). She is convinced prevalence is much higher in Europe than statistical estimates of one in 3,500 pregnancies.
In preliminary research, Hilfiker-Kleiner has found that bromocriptine may be a cheap and easy treatment option for preserving or increasing left ventricular function and dimensions in high risk patients (Cell 2007; 128:589-600). This may be particularly useful in developing countries where prevalence is high, but it would prevent breast feeding and could only be taken where there were proven benefits to the mother.