Ms Tone Merete Norekval,
Tone Merete NorekvalChristi Deaton
Professor Fridlund (Jonkoping, SE) emphasized the need to increase awareness of heart disease in women. Women are still under-diagnosed, under-treated and under-researched. He suggested that cognitive and behavioural variables may contribute to explain gender differences. Women tend to express their symptoms differently, and also report a larger number of symptoms. However, both men and women have atypical symptoms. Fridlund concluded that it is less important which gender has typical or atypical symptoms. Rather, it is important that clinicians and patients recognise the spectrum of clinical presentation of heart disease.
Dr Stevenson (London, GB) noted that HRT has gone from being seen as a positive treatment to a treatment that is not safe after the Womens’ Health Initiative report in 2002. Although observational trials have proven a benefit of HRT, randomized trials have not, which Dr Stevenson attributed to problems with dose, type and the age of the patient.
Dr Stevens answered the following three questions: HRT for whom, when and for how long? Women with symptoms and risk of osteoporosis should be targeted. However, HRT should not be used for primary prevention of CHD. Treatment should start soon after menopause, and continue until treatment aims are achieved. He underlined that we need more data regarding women and heart disease, and specifically also on HRT.
The lack of data on women was also brought up by Dr Groebbe (Utrecht, NL) when discussing statin therapy for women. Cholesterol sceptics state that we have no evidence in women and therefore should not prescribe. Although data on use of statins in women are scarce, Dr Groebbe showed that data are convincing for combination populations (women and men), and especially convincing for high risk women. The absolute risk is lower for women than men and consequently the benefit is also possibly higher for men. However, the recently published Jupiter study (Ridker et al NEJM 2008) proved the same risk reduction in women as in men. Also a Japanese study (Mizuno et al Circulation 2008) showed reduced total mortality in women but not in men. Dr Groebbe concluded that statin therapy is indicated also in women. However, as most data on benefits of lipid lowering therapy are in men there is a call for additional studies with reasonably sized samples of women.
A woman's heart
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