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Press Release Date: July 10, 2003
Although coronary heart disease (CHD) is the cause of 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 and minorities. As a result, many of the tests and therapies that are used to treat women for CHD are based on studies conducted predominantly in men.
Even in studies that include women, the published research often does not provide findings specific to women, according to two evidence reviews on CHD in women, conducted for the Agency for Healthcare Research and Quality and the National Institutes of Health's Office of Research on Women's Health by researchers at the University of California at San Francisco/Stanford Evidence-based Practice Center. Only 20 percent of the articles reviewed for this project provided separate findings on women.
The U.S. Department of Health and Human Services, which includes AHRQ, has been working to expand the involvement of women in research involving CHD. For example, the NIH's National Heart, Lung, and Blood Institute supports a wide range of clinical trials on heart disease that have included women, including large studies such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM). In addition, the Women's Ischemia Syndrome Evaluation (WISE) study is investigating issues related to the specific symptoms of chest pain in women and the diagnosis of CHD. The NIH also has been working with scientific journals to encourage the publication of more research data specific to women.
In reviewing studies that did publish findings specific to gender or race/ethnicity, the researchers found that:
- Fair or good evidence suggests that the use of diagnostic tests and treatments may differ by gender. Men are more likely than women to undergo diagnostic testing and treatment for CHD, but women are more likely to be treated for hypertension.
- Fair or good evidence suggests that beta-blockers, aspirin, and angiotensin-converting enzyme inhibitors reduce risk for CHD events.
- Good evidence suggests that treatment of hypertension lowers the risk for CHD events in women, and that these benefits may be greater in African-American women.
- Fair evidence suggests that smoking cessation after heart attack lowers the risk for CHD in women.
- Fair evidence suggests that women who receive glycoprotein IIb/IIIa inhibitor drugs during coronary procedures seem to benefit from this treatment, but good evidence suggests that use of glycoprotein IIb/IIIa inhibitor drugs in women with acute coronary syndromes may be associated with an increased risk of death. This was the only treatment studied for which there was evidence that the outcomes may be different between men and women. Men treated with glycoprotein IIb/IIIa inhibitor drugs during acute coronary syndromes appeared to benefit.
The researchers conclude that even though funding agencies appear to have succeeded in ensuring that some women and minorities are included in randomized trials, data about these populations often are not made clear in the published findings. They recommend that in addition to requiring participation of women and minorities in research, funding and regulatory agencies should request that outcome data by gender and race/ethnicity be published or made easily available.
Details of these findings from the following two evidence reports can be found on the AHRQ Web site: Results of Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women at http://www.ahrq.gov/clinic/epcsums/chdwomsum.htm; Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics at http://www.ahrq.gov/clinic/epcsums/chdwtopsum.htm. In addition, the information can be found on the National Guideline Clearinghouse™ at http://www.guideline.gov (Select EPC Reports). Printed copies also are available from the AHRQ Clearinghouse at 800-358-9295, or AHRQPubs@ahrq.hhs.gov.
For more information, please contact AHRQ Public Affairs:
Karen Carp, (301) 427-1858 (KCarp@ahrq.gov); Farah Englert (301) 427-1865 (FEnglert@ahrq.gov).