Ideal Blood-Pressure?; “We Have No Idea”

May 3, 2012| Topic: Education, Research

TheHeart.org reported today that experts speaking at the European Meeting on Hypertension 2012 this past weekend admitted there is much that remains unknown in the field hypertension. Evidence for seemingly straightforward issues, such as what should be the ideal number to lower blood pressure to in different groups of individuals, is lacking and many new trials need to be performed. In the meantime, guidelines need to offer the best direction they can for those who have the task of treating hypertension.

Hypertension poses a significant risk to women. An increase in the overall rates of obesity and diabetes have led to more uncontrolled hypertension, which in turn leads to numerous complications which often require revascularization. As it relates to women, after the age of 55, they are at an increased risk for hypertension when compared to men and yet are less likely to receive revascularization. With a growing patient population experiencing hypertension, physicians need to be aware of how to address it appropriately, especially in their female patients.

WIN is putting a focus on this subject matter, conducting a symposia series around hypertension and atrial fibrillation. A lunch program was held during TCT 2011, and another is planned for ESC 2012. The goal is to educate the interventional cardiology community on how to best address uncontrolled hypertension in the female population.

 

CREATE Registry Highlights Gender Disparities, Cultural Implications

April 19, 2012| Topic: Research

Data from the CREATE registry was presented at the World Congress of Cardiology this week. The registry, which enrolled over 20,000 patients from 50 cities in India, revealed that it took, on average, 35 minutes longer for women to get to the hospital than it took men and, once there, they were significantly less likely to undergo angiography, thrombolysis, or coronary interventions. 30 day mortality rates were also higher in women than in men.

Interestingly, CREATE showed that women were likely to receive aspirin and beta blockers at roughly the same rates as men, but that the more expensive drugs—ACE inhibitors and angiotensin-receptor blockers (ARBs), as well as statins—were used much more commonly in men.

Study investigators suggested that Indian culture might play in these differences. It was speculated that many Indian physicians still work with the impression that heart disease is a man’s disease, and that the level of responsiveness to women with heart disease is low. Additionally, cost of care in India is high, and women are perhaps less likely to voluntarily come out of pocket for their own health.

These and other social and cultural complexities make it difficult to assess health disparities in a way that allows for simple solutions. A layered approach, mixing culturally sensitive physician and patient education, finding new ways of collecting and analyzing data, and pushing the boundaries of innovation will provide a long term solution for women with heart disease.

 

Project Implicit – Understand Your Own Biases

April 18, 2012| Topic: Professional Development

Part of WIN’s mission is to increase the number of women in the field of interventional cardiology. The goal is not only to assist female physicians in fulfilling their own professional goals, but to assist in diversifying the cardiology workforce (in which women are woefully underrepresented). WIN’s belief is that a more diverse workforce will allow for a diversified and effective approach to the care of different patient populations. Specifically, a more effective approach to the diagnosis and treatment of women with heart disease.

At a healthcare disparities hearing on Capitol Hill this morning, Dr. Lawrence Tabak, Deputy Director of the National Insitutes of Health (NIH) noted that the NIH is working to diversify its own workforce. He emphasized that diversifying the workforce of any organization is vital to its success, and suggested that as individuals we all carry our own, unrealized biases into our work places. Biased thinking can lead to slowed progress at best and discrimination at worst, and is clearly something to actively try to avoid.

In his talk, Dr. Tabak made mention of a Harvard-based program called Project Implicit. Project Implicit was born out of the theory that people don’t always “know their minds,” and that this lack of understanding can lead to unintended biased decision making.  Visit the site and take the Implicit Association Test to uncover your own biases. You might be surprised at what you find.

 

DES Associated with Similar Outcomes Among Women and Men

April 16, 2012| Topic: Research

A new study in the March issue of JACC pooled data from three DES trials (SIRTAX, LEADERS and RESOLUTE) to study sex-based differences in DES usage. Study findings were summarized as follows;

• Women undergoing PCI with the unrestricted use of DES differ from their male counterparts and are typically older, have more cardiovascular risk factors except for smoking and a lower degree of angiographic complexity as assessed by the SYNTAX score.
• After controlling for baseline differences, women undergoing PCI with DES have a similar risk of cardiac death and MI as compared with men through two years of follow-up.
• DES achieves equivalent safety and efficacy in women and men with similar results in terms of stent thrombosis, repeat revascularization and angiographic outcomes through two years of follow-up.

“So, have we answered most of the questions with regard to cardiac differences between men and women? Not by a long shot,” wrote editorialist and WIN Member Cindy L. Grines, MD.

WIN plans to host a second gender data forum in September of 2012. This time the focus will be on devices (the first forum, held in December of 2011 was focused on ACS/AMI drug trials). WIN aims to further explore differences in prevalence, mechanism, manifestation and treatment of cardiovascular disease in women.

To view the JACC article, click HERE.

To view additional editorial comments from Cardiovascular Business, click HERE.

 

 

OBGYN Screening Efforts Receive Ongoing Media Attention

April 5, 2012| Topic: In The News