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Existing coronary heart disease is undiagnosed in half of women who have a first heart attack

Coronary heart disease (CHD) is the leading killer of women in the United States. Yet, nearly half of women who suffer a first heart attack have not been diagnosed with CHD prior to the attack. Furthermore, many of these women have cardiac risk factors such as high blood pressure (hypertension), obesity, and diabetes that are not treated, according to a study supported by the Agency for Healthcare Research and Quality (HS10239). These findings show that there are missed opportunities to treat women to prevent cardiac problems, concludes Barbara P. Yawn, M.D., M.Sc., of the Olmsted Medical Center.

Dr. Yawn and her colleagues reviewed the medical records of women from one Minnesota county who had suffered a heart attack between 1996 through 2001. The researchers reviewed the women's records for 10 years prior to their heart attack and examined the timing of CHD diagnosis and assessment and treatment of their risk factors for cardiac problems.

A total of 150 women (average age 75) suffered a heart attack during the 6-year period. Even though the women made a total of 8,732 outpatient visits and had 457 hospitalizations during the 10 years prior to their first heart attack, only 52 percent of them had been diagnosed with CHD. Women 70 years or older at the time of heart attack were three times as likely as younger women to have been diagnosed with CHD prior to their first cardiac event.

Clinicians did identify one or more treatable cardiac risk factors among all but three women prior to their first heart attack, yet treatment of these risk factors varied. About 81 percent of women with hypertension were prescribed antihypertensive medications, but only 28 percent of women were prescribed drug therapy for abnormal cholesterol or other lipid levels. Women who were diagnosed with CHD were more likely than undiagnosed women to receive drug treatment for identified cardiac risk factors.

See "Identification of women's coronary heart disease and risk factors prior to first myocardial infarction," by Dr. Yawn, Peter C. Wollan, Ph.D., Steven J. Jacobsen, M.D., Ph.D., and others in the Journal of Women's Health 13(10), pp. 1087-1100, 2004.

Editor's Note: Another AHRQ-supported study on a related topic found that both recent and long-term diabetes puts men at similarly high risk for CHD death as heart attack. For women, the results are similar for short-term diabetes, but long-term diabetes puts them at even greater risk than heart attack for CHD death. These findings suggest the need for more intensive treatment of women with long-term diabetes. For more details, see Natarajan, S., Liao, Y., Sinha, D., and others (2005, February). "Sex differences in the effect of diabetes duration on coronary heart disease mortality." (AHRQ grant HS10871). Archives of Internal Medicine 165, pp. 430-435.

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