November 30, 2009
Cardiovascular Disease And Women: When Catching Up With The Guys Is Not A Good Thing
By Michael D. Shaw
While the exact mechanism is still unclear, it is well-known that estrogen protects women from developing certain types of heart disease. As such, pre-menopausal women tend to be at less risk than men of similar age, although recent studies show that the gap is narrowing. In fact, this gender gap has been decreasing for the past 20 years, and it’s not only because the rate in women is increasing, either. Apparently, the heart disease rate in middle-aged men is dropping, as well.
To make matters worse, women tend to have atypical symptoms during a heart attack, and because of this, more complications may ensue, based on a later diagnosis. Women are generally older at the time of their first attack, making complications more likely. With smaller hearts and coronary arteries than men, as well as the interference of breast tissues, certain diagnostic and therapeutic procedures can also be more difficult.
In a study entitled “Sex-Specific Trends in Midlife Coronary Heart Disease Risk and Prevalence,” published in Archives of Internal Medicine, smoking gets part of the blame as fewer women are quitting. Another disturbing finding is that risk factors including blood pressure and total cholesterol got worse in women, while improving in men.
The authors suggest that “Greater emphasis on vascular risk factor control in midlife women might help mitigate this worrisome trend.” Numerous websites provide suggestions for lifestyle improvements, such as considering a healthier diet, more exercise, and stress reduction techniques.
Another tool in this fight against risk factors is the use of statins—anti-cholesterol medications. Some encouraging results have come out of the so-called JUPITER study. (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin.)
JUPITER was a randomized, double-blind, placebo-controlled, multi-center trial conducted at 1315 sites in 26 countries, involving 17,802 patients. The trial was financially supported by Astra-Zeneca, manufacturers of Crestor®. The sponsor collected the trial data and monitored the study sites, but played no role in the conduct of the analyses or drafting of the manuscripts submitted for publication, and had no access to the unblinded trial data until after the manuscript was submitted for publication.
Initial results from JUPITER were presented November, 2008 in the New England Journal of Medicine. The findings were that Crestor reduced heart attack, stroke, need for bypass or angioplasty procedures, and cardiovascular death by 45 percent over less than two years. It is noted that the patients in the study had healthy cholesterol levels but high levels of a protein associated with inflammation and heart disease (high-sensitivity C-reactive protein), suggesting the drug may have substantial benefits even for those who do not have high levels of bad LDL cholesterol.
Additional analyses of the JUPITER data were presented recently at the American Heart Association Annual Scientific Sessions in Orlando, Florida. A key finding emerged for the ladies…
In a cohort of 6,801 women, Crestor reduced cardiovascular (CV) events [defined as the combined risk of myocardial infarction (heart attack), stroke, arterial revascularization, hospitalization for unstable angina, or death from CV causes] by 46 percent in women without cardiovascular disease, but at increased risk of a cardiovascular event as identified by age and elevated levels of the protein mentioned above. The largest benefit for women was for arterial revascularization (76 percent reduction). This analysis also showed a 42 percent reduction in CV events for men.
“Nearly twice as many women die of heart attacks, strokes and other cardiovascular diseases as from all forms of cancer, including breast cancer,” said Alex Gold, MD, AstraZeneca’s U.S. director for Crestor clinical development. “Women have been an underrepresented population in primary prevention statin outcome trials, and there has been limited evidence that women can benefit from statin therapy. JUPITER is the first statin study to have shown a significant reduction in the risk of cardiovascular events in women without established cardiovascular disease.”
One other finding was that patients who achieved very low LDL levels with the drug (less than 50 mg/dL), showed a 63 percent reduction in CV events and a 51 percent greater reduction in CV events, than patients not achieving low LDL levels.
Paul Ridker, MD, of Harvard Medical School, the lead investigator on JUPITER notes that the trial was stopped more than two years early since an overwhelming benefit for patients was demonstrated. He said that “The big message is women should sit down with their doctors to see if they can lower the risk of heart attack.”