Andrea Dunaif, MD: Cardiovascular Disease in Women

Cardiovascular disease (CVD) is an overwhelming presence in US health care. According to the American Diabetes Association (ADA), CVD is up to 4 times more prevalent in adults with diabetes — a condition currently affecting about 30 million Americans. It is also the leading cause of disability and death in said patients, and the conditions are responsible for more than 12% of all money spent in health care — nearly $500 billion annually.

The crux of concern for CVD risk is designated to male patients. Ironically, Andrea Dunaif, MD, said it's the leading cause of death in women.

While attending the 2018 ADA 78th Scientific Sessions in Orlando, FL, the chief of the Hilda and J. Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine sat down with MD Mag to discuss how the comorbidities and conditions most closely associated with diabetes affect female patients.

Of course, none are more crucial than CVD.

"But even more concerning, physicians who care for these women are not giving attention to modifiable risk factors in women that they do in men," Dunaif said.

Dunaif discussed all the elements that have led to an underwhelming national response to CVD in women.

Andrea Dunaif, MD, chief of the Hilda and J. Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine: So, cardiovascular disease is the leading cause of death in women, and it has been a public education effort to make women aware of that fact. About 10 years ago, women thought that breast cancer was the leading cause of death which, although it is an important disease — especially in women in their 40s and 50s — it is not the leading cause of death.

Women are not as concerned about cardiovascular disease, and because of educational efforts, women now realize they should be concerned about cardiovascular disease. But even more concerning, physicians who care for these women are not giving attention to modifiable risk factors in women that they do in men. There are many things. High lipid levels, high cholesterol, things that can be treated aggressively in women but are in men are because the health care providers aren't cognizant or don't have in their front-of-mind cardiovascular disease risks in women.

In diabetes, it's very important, because the prevalence of diabetes removes the protection of being a pre-menopausal woman. Pre-menopausal women are better protected to heart disease compared to men. However, once a pre-menopausal woman develops diabetes, she goes up to male rates of cardiovascular disease. In fact, the weights of cardiovascular disease become worse than they are in men. I think that's another gender difference that does not have the public awareness that's important.

Lastly, the symptoms of cardiovascular disease are different in men and women. So women present, when they're having their events with what we consider atypical pain — atypical for a male. So what women often have — jaw pain, more defuse pain rather than the crushing left sub-sternal pain that you associate with a heart attack. They may also just feel tired or very non-specific symptoms.

So, all of these factors together make women more likely to die from their acute cardiovascular events than men. We've looked at the death rates from cardiovascular disease over the years, and they have been dropping much more rapidly in men than they have in women.

And it's only recently that we're starting to bend the curve down within death rates in women.

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