Over the past few years, February has become the month when we pay particular attention to heart health in women. Since the respective launches of the National Heart, Lung, and Blood Institute's "Heart Truth" campaign and the American Heart Association's "Go Red for Women," the topic of heart disease in women has received attention in the professional literature and in the lay press. Newly published research, surveys, and guidelines can provide important talking points for clinicians with educational efforts in the clinical and community settings. The observance of "National Wear Red Day" Day on February 3 provides an appropriate time to reflect on the latest information.

Physiological Differences

Surprising news emerged from the American Heart Association's 59th Annual Fall Conference and Scientific Sessions of the Council for High Blood Pressure Research. Study of the effects of single nucleotide polymorphisms demonstrated that many of these genetic variations had opposite effects on the risk of hypertension in women and men. The researchers concluded that gender will need to be part of the equation as genetic predictors are developed. This work raises the possibility that studies may need to be done separately on men and women and that ultimately hypertension may be treated differently based on gender.1

Khera et al2 examined data regarding levels of C-reactive protein according to race and sex in an urban, multiethnic population. These data, from the Dallas Heart Study, noted marked differences between men and women and between whites and blacks. The study revealed that weight-adjusted CRP levels were lowest in white men and highest in black women. Additionally, white women had higher CRP levels than black men, despite the fact that black men are, in general, at higher CVD risk than white women. It was also noted that CRP levels rise with obesity to a higher degree in women than in men.

The gender disparity in the impact of diabetes on cardiovascular risk continues to be demonstrated. Finnish researchers, in an article published in the Journal of the American College of Cardiology in May 2005,3 examined predictors of cardiovascular disease mortality risk. Prior diabetes carried a poorer prognosis in women, whereas history of MI was more detrimental in men. Delivering the message about prevention of type 2 diabetes to women is an important theme.

Disparities in Care and Outcomes

A report in the Archives of Surgery in September 2005 revealed that gender does not alter outcome in patients who undergo balloon angioplasty for peripheral vascular disease. The study, reporting on 350 patients who had undergone angioplasty of lower extremity occlusions, demonstrated similar long-term outcomes in men and women.4

Blankstein et al,5 in an article published in Circulation in late August, noted that while smaller body size accounts in part for mortality in women following bypass surgery, neither smaller body mass nor smaller vessels explain the higher risk for women. The data were from more than 15,000 patients in 31 US hospitals. After adjustment for comorbidities and body size, the mortality for men was 2.43% and for women it was 3.81%.

In July 2005, the Kaiser Family Foundation released the results of a national survey which demonstrated a gap in healthcare for women. The survey, designed to examine the state of healthcare for women found that many do not receive adequate preventive care. This survey of nearly 3,000 women 18 and older demonstrated that only about 55% have talked to a healthcare provider about diet, exercise, and nutrition during the past 3 years. For women who are chronically ill, poor, and/or uninsured, the challenges to receiving adequate care were greater.6

Several articles relative to both race and sex-based disparities in care appeared in the August 18 issue of the New England Journal of Medicine. Vaccarino et al,7 in an examination of National Registry of Myocardial Infarction data, sought to discover whether differences in treatment based on race or sex changed over the period 1994-2002. Patients were evaluated for use of evidence-based guidelines and discovered that race and sex disparities in treatment persist. It was additionally noted that the group that was least likely to receive guideline-based treatment had the highest mortality.

Public Awareness Surveys

Surveys evaluating changes in women's awareness of their risk of cardiovascular disease continue to show incremental improvement, although clearly there is great opportunity for continued dissemination of the message. A survey by the Society of Women's Health Research released July 7, 2005 indicates that since 2002, women's fear of heart disease has nearly doubled. The percentage of women for whom heart disease was their greatest fear rose from 5.3% to 9.7%. Cancer, and particularly breast cancer, still ranks highest among the most feared diseases.8

Results of a Harris interactive survey released July 19, 2005 indicates that most women feel that they are knowledgeable about cholesterol and realize its importance. Surprisingly, despite this, the majority (59%) of women surveyed did not know that LDL is the "bad" cholesterol and HDL is the "good," Most did not know their own LDL, triglyceride, and HDL levels-again, a gap in personalizing the seemingly ubiquitous public health information. Approximately 2,700 women age 50 and over were surveyed, about 25% of whom had a history of cardiovascular disease. In response to this information and with the support of an educational grant by Kos Pharmaceuticals, the Preventive Cardiovascular Nurses Association launched a public education program to raise awareness about the various elements of the cholesterol profile and the importance of each, with a particular focus on the importance of HDL and triglyceride levels in women.9

For additional information and insight, the September/October issue of the Journal of Cardiovascular Nursing contained a well-written and well-referenced overview on heart disease in women.10 "Gender Differences in Coronary Artery Disease" by Eastwood and Doering provided a review of gender differences in physiology, risk factors, and clinical presentation. Also noted is the evidence for gender differences in treatment, including potential issues around gender bias. Continuing education credits were associated with this excellent review. There continues to be a key role for nurses in the areas of research, advocacy, patient and professional education in the efforts to raise awareness and erase the gender disparities in treatment and in outcomes.

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