Experts estimate that one in two women will die of heart disease or stroke, and statistics reveal significant differences between men and women in survival following a heart attack. Research shows that women may not be diagnosed or treated as aggressively as men, and their symptoms may be very different from those of men having a heart attack.
Findings from current research projects of the Agency for Healthcare Research and Quality (AHRQ) focusing on cardiovascular disease in women are summarized here.
Select to download print version (PDF File, 274 KB; PDF Help).
Introduction | AHRQ-Sponsored Research | More Information
Cardiovascular disease (CVD) is the number one killer of women in the United States. Long thought of as primarily affecting men, we now know that CVD—including heart disease, hypertension, and stroke—also affects a substantial number of women. Experts estimate that one in two women will die of heart disease or stroke, compared with one in 25 women who will die of breast cancer.
Current statistics reveal significant differences between men and women in survival following a heart attack. For example, 42 percent of women who have heart attacks die within 1 year compared with 24 percent of men. The reasons for this are not well understood. The explanation accepted by many is that women tend to get heart disease about 10 years later in life compared with men, and they are more likely to have coexisting, chronic conditions. However, research also has shown that women may not be diagnosed or treated as aggressively as men, and their symptoms may be very different from those of men who are having a heart attack. In addition, new studies indicate that men and women react to drugs prescribed for heart disease and other women.
Differences between white and black women in heart disease mortality are substantial. Deaths due to heart disease are about two-thirds higher among black women than among white women. However, heart disease mortality is lower among Hispanic, American Indian, and Asian/Pacific Islander women compared with white women.
The Agency for Healthcare Research and Quality (AHRQ) supports a vigorous women's health research program, including research focused on CVD in women. AHRQ-supported projects are addressing women's access to quality health care services, accurate diagnoses, appropriate referrals for procedures, and optimal use of proven therapies.
Following are examples of current AHRQ research projects focused on CVD and women, as well as findings from recently published studies.
These researchers are examining medical record data to compare the duration of coronary heart disease, symptoms, diagnostic evaluations and referrals, and the assessment and treatment of modifiable risk factors for coronary heart disease for the 10-year period prior to a first heart attack in men and women.
Barbara P. Yawn, Principal Investigator (AHRQ grant HS10239).
Although coronary heart disease (CHD) causes more than 250,000 deaths in women each year, much of the research in the last 20 years on the diagnosis and treatment of CHD has either excluded women entirely or included only limited numbers of women. As a result, many of the tests and therapies used to treat women for CHD are based on studies conducted predominantly in men, according to two evidence reviews on CHD conducted by AHRQ's Evidence-based Practice Center (EPC) at the University of California, San Francisco/Stanford.
The reviews examined:
Key findings of the study indicated that no evidence addressed differences in the accuracy of diagnostic tests, strength of risk factors, effects of treatment, or prognostic value of markers for ischemia in women of different races or ethnicity. Beta-blockers, aspirin, and angiotensin converting enzyme (ACE) inhibitors were found to reduce risk for CHD events in women with known heart disease. Use of nitrates was not associated with reduction in the risk for CHD events in women with known disease. Glycoprotein IIb/IIIa inhibitor drugs given to women undergoing coronary angioplasty resulted in a reduced risk of CHD events and the need for revascularization, but use of this treatment in women suffering from acute coronary syndromes may increase mortality.
Copies of the two reports, Results of a Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women, Evidence Report/Technology Assessment No. 80 (AHRQ Publication No. 03-E035, full report; 03-E034, summary) and Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics, Evidence Report/Technology Assessment No. 81 (AHRQ Publication No. 03-E037, full report; 03-E036, summary) are available from AHRQ (contract 290-97-0013).*
Researchers at AHRQ's Southern California EPC examined evidence on pharmacologic management of heart failure and found that treatment with ACE inhibitors was beneficial in women, but it did not reduce mortality in women with asymptomatic left ventricular systolic dysfunction. They also found that both women and men with symptomatic heart failure have reduced mortality when treated with beta-blockers.
Copies of Evidence Report/Technology Assessment No. 82, Pharmacologic Management of Heart Failure and Left Ventricular Systolic Dysfunction: Effect in Female, Black, and Diabetic Patients, and Cost-Effectiveness (AHRQ Publication No. 03-E044, summary; 03-E045, full report) are available from AHRQ (contract 290-97-0001).*
An analysis of data on 327,040 men and women enrolled in a national registry of patients revealed that women were less likely to receive aspirin, beta-blockers, intravenous heparin, or nitrate therapies within the first 24 hours of hospital admission. They also were less likely to undergo coronary angiography, angioplasty, or bypass surgery, but they were more likely to die in the hospital. Insurance status did not explain the differences between men and women in heart attack treatments and outcomes.
Canto, Rogers, Chandra, et al., Arch Intern Med 162:587-593, 2002 (AHRQ grant HS08843).
Researchers at the Johns Hopkins Evidence-based Practice Center examined the available evidence on the utility of blood pressure (BP) monitoring outside of the clinic setting. Although they found some support for the use of ambulatory BP monitoring, in general, the evidence was insufficient to compare clinic BP monitoring with BP monitoring elsewhere. Evidence on BP monitoring among population subgroups was rarely stratified by race or sex. The only notable subgroup finding was a higher prevalence of white-coat hypertension in women. However, the evidence was insufficient to determine whether the risks associated with white-coat hypertension are sufficiently low to consider withholding drug therapy in this large subgroup of hypertensive patients.
Copies of Evidence Report/Technology Assessment No. 63, Utility of Blood Pressure Monitoring Outside of the Clinic Setting (AHRQ Publication No. 03-E003, summary; 03-E004, full report) are available from AHRQ (contract 290-97-0006).*
In an editorial accompanying study findings on male and female mortality rates after heart attack, this researcher notes that the interaction of age and sex remains a significant predictor of heart attack-related death, even after adjustment for demographic factors, clinical characteristics, and inpatient cardiac care. The study reported an 11 percent 2-year mortality rate for women before age 60 (vs. 7 percent for men) and a lower mortality rate for women after age 79 (46 vs. 51 percent for men). The author notes that nonbiological factors may play a role, including behavioral, psychological, and social factors such as smoking, adherence to medication regimens, depression, social isolation, low income, and emotional stress.
Ayanian, Ann Intern Med 134(3):239-241, 2001 (AHRQ grant HS09718).
Emergency room doctors miss diagnosing about 2 percent of patients with heart attacks or unstable angina because they do not have chest pain or other symptoms typically associated with a heart attack. When these patients are mistakenly sent home from the ER, they are twice as likely to die from their heart problems as similar patients who are admitted to the hospital. The patients in this study who were misdiagnosed tended to be women under the age of 55 or minorities who reported shortness of breath as their chief symptom, instead of chest pain, and/or to have apparently normal electrocardiograms.
Pope, Aufderheide, Ruthazer, et al., New Engl J Med 342(16):1163-1170, 2000 (AHRQ grant HS07360).
Most of the 1 million U.S. patients who suffer a heart attack each year are candidates for reperfusion therapy, either thrombolytic (clot-busting) drugs or primary angioplasty. In a study of nearly 27,000 Medicare beneficiaries who met the strict criteria for reperfusion therapy between February 1994 and July 1995, only 44 percent of eligible black women received the treatment, compared with 59 percent of white men, 50 percent of black men, and 56 percent of white women.
Canto, Allison, Kiefe, et al., New Engl J Med 342(15):1094-1100, 2000 (AHRQ grants HS08843 and HS09446).
Coronary artery disease risk is higher in certain women with angina, according to researchers who examined correlates of angina in men and women aged 35 to 55. This is particularly true for women who have a poor cardiovascular risk profile and symptoms such as shortness of breath.
Nicholson, White, Macfarlane, et al., J Clin Epidemiol 52(4):337-346, 1999 (AHRQ grant HS06516).
In this study of 454 Rochester, MN, residents who had a first ischemic stroke between 1985 and 1989, the risk of stroke due to atherosclerosis with narrowing of the blood vessel was four times greater in men than in women (47 vs. 12 per 100,000 population). This could help to explain why U.S. rates of carotid endarterectomy (surgical opening of a blocked carotid artery) are 30 to 60 percent higher in men than in women.
Petty, Brown, Whisnant, et al., Stroke 30:2513-2516, 1999 (Stroke Prevention PORT, contract 290-91-0028).
In this study, blacks and women, particularly black women, had statistically significant lower odds for being referred for cardiac catheterization than whites and men. The study involved 720 primary care doctors and eight patient actors (two each black men, black women, white men, and white women) who used the same scripts to report the same symptoms, wore identical gowns, used similar hand gestures, and had the same insurance and professions.
Schulman, Berlin, Harless, et al., N Engl J Med 340:618-626, 1999 (AHRQ grant HS07315).
For more information on AHRQ initiatives related to women's health, please contact:
Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D.
Senior Advisor on Women's Health
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Phone: (301) 427-1550
E-mail: RCorrea@ahrq.gov
Select for more information about AHRQ's research portfolio and funding opportunities.
* Items marked with an asterisk are available free from the AHRQ Clearinghouse. To order, contact the Clearinghouse at:
Phone: 1-800-358-9295 (outside of the U.S., phone 410-381-3150)
E-mail: ahrqpubs@ahrq.gov
Please use the AHRQ publication number when ordering.
AHRQ Publication No. 04-P003
(Replaces AHRQ Publication No. 01-P016)
Current as of October 2003
Internet Citation:
Research on Cardiovascular Disease in Women. Fact Sheet. AHRQ Publication No. 04-P003, October 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/womheart.htm
Return to Fact Sheets
Women's Health
AHRQ Home Page
Department of Health and Human
Services