Women who have served in the military often return to civilian life unaware they face danger from a potentially hidden and deadly enemy — heart disease. Cardiovascular disease is the top killer of all U.S. women, including women veterans, according to the American Heart Association (AHA).
However, women veterans appear to have challenges with heart disease that set them apart from male veterans and women who never served in the armed forces, according to researchers from the University of Michigan and Veterans Administration (VA) Ann Arbor Healthcare System.
Their study, published in the AHA journal Circulation: Cardiovascular Quality and Outcomes, found significant differences not only between heart disease pain symptoms in women vets but also in the treatment they received compared to former male soldiers.
The research team looked at records of nearly 86,000 veterans, including 3,181 women, undergoing cardiac catheterization at VA medical centers for chest pain. Catheterization, which involves a long, thin, flexible tube called a catheter that is placed into a blood vessel and threaded to your heart, is used to diagnose and treat heart conditions such as narrowed and blocked arteries that can cause a stroke or heart attack.
The average age of female vets suffering from cardiac pain that prompted the catheterizations was 57, six years younger than the median age of male veterans with the same symptoms. But doctors were far less likely to find any narrowed arteries and blockages when they performed the test on women compared to men, according to cardiologist Melinda B. Davis, MD, of the University of Michigan Frankel Cardiovascular Center and the VA Ann Arbor Healthcare System, who headed the study.
Does being blockage-free mean the women veterans who complained of chest pain were free of heart disease? Not necessarily.
The researchers suggested that because women are generally underrepresented in heart disease research, doctors can lack important information about how women can present with heart disease symptoms. So doctors testing women veterans with chest pain symptoms might have overlooked cardiovascular problems such as stress-induced heart disease and coronary microvascular disease, which can cause tiny blood vessels to spasm, producing sometimes severe chest pain. (The AHA has more information about how a woman’s symptoms can differ from a man’s.)
In addition, the study found that women veterans with cardiac symptoms were more obese than their male counterparts. The women also were more likely to suffer from post-traumatic stress disorder and had a much higher rate of depression than men, pointing to mental health problems as potential risk factors for chest pain.
"Investigating the reasons behind these findings and developing effective approaches based on those insights could potentially help address the gender differences in heart disease we see in the general population," said Claire Duvernoy, MD, chief of cardiology at VA Healthcare Ann Arbor.
Research has also shown that women veterans may not receive adequate medication to help prevent or treat heart disease. For example, the Circulation study found that when doctors did spot acute heart disease in women vets, the patients were less likely than men veterans to have heart medications for their condition when they left the hospital. (See VA resources for women veterans with heart disease.)
A collection of studies on healthcare for women’s cardiovascular risks, published in the George Washington University public health journal Women's Health Issues (WHI), included research showing women veterans tend to have higher levels of the “bad” cholesterol, LDL, than their male counterparts. And research from the University of California showed too many women veterans are not being given — or are not taking — medication to control their elevated cholesterol, a risk for heart disease.
"Many people still don't realize that heart disease is the number one killer of women," said sociologist Chloe Bird, editor-in-chief of WHI. "Women should be getting treated for high blood pressure, high cholesterol, and other conditions that pose risks to their long-term cardiovascular health — but research is finding that education and healthcare still need to improve so women get the necessary preventive care."
April 09, 2015
Christopher Nystuen, MD, MBA