BACKGROUND
In 1987 and 1992, the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) convened task force conferences on cardiovascular health and disease in women. More recently, while under the directorship of Bernadine Healy, the NIH established a national Office of Research on Women's Health. These events have focused the national spotlight onto women's health issues. The task the nation has been charged with on the recommendation of the proceedings 1 from these national agencies is ambitious indeed: to direct health care resources toward improving all aspects of women's health and cardiovascular health to include clinical services, education, and research. This mandate will do much to help dispel the myths and address the controversies that have surrounded women's health issues and contributed to relative past inaction.
Although a number of health problems are unique to women or affect them disproportionately (e.g., pregnancy, breast and uterine cancer, and osteoporosis) this chapter focuses on cardiovascular disease in women and, in particular, CHD because of its overwhelming, though underrecognized, importance to the health of American women. Within this context, a number of significant myths and controversies have been identified and are highlighted here.
Myths surrounding the available medical and epidemiologic knowledge and its application are as follows:
- Coronary heart disease is a disease that affects primarily men, whereas breast cancer is the major health threat for women.
- Women appear to be at less risk for CHD than their male counterparts.
- Changing hormonal status and menopause confound our understanding of the impact of heart disease in women.
- No gender differences exist in therapeutic treatment approaches and applications for men and women with CHD.
Controversies in heart disease in women relate to the following:
- Perceptions of heart disease risk and cardiovascular disease outcomes by both patients and health care providers
- Differences in, and the role of, psychosocial perspectives and attitudes in clinical decision making
- Controversies in management decisions and treatment applications amid a gender gap in medical research
By understanding which factors are critical in the epidemiology, pathogenesis, treatment, and outcome for women with CHD, health care consumers, providers, educators, and policy makers can collectively become more informed partners and make a significant impact in a disease process that still remains largely undertreated and underdiagnosed in women.