Scott Webb: Although women suffer from cardiovascular disease at the same rate
as men, there are disparities in diagnosis and treatment for women that can lead
to worse outcomes for these patient's.
And joining me for a second time today to help us to understand the disparities
and offer some solutions is Dr.
Steven Cook.
He's a board-certified cardiologist, subspecializing in non-invasive
cardiology at Franciscanhealth.org.
Scott Webb (Host): This is the Franciscan Health Doc Pod.
I'm Scott Webb.
Scott Webb: Doctor, it's great to have you back on the podcast.
Today we're talking about women equity and access to care And the
disparities And what we can do about it.
So let's start there.
Talk to me a little bit about listeners, about the disparities in
diagnosis and treatment for women.
Dr. Stephen Cook:
When I think about cardiovascular disease, we know that This is the leading cause of
death among women in the United States.
, More lives are actually lost from cardiovascular disease.
Compared to lives lost from cancer and chronic lung disease, and half of
the 27 million Americans living with cardiovascular disease are women,
but yet it remains underdiagnosed, undertreated, and often for tens worse
outcomes in women compared to men.
Scott Webb: Hmm.
Dr. Stephen Cook:
And so I'm still confused as to why this often happens.
I think it's really important for us to kind of start to begin to
review cardiovascular risk factors and disparities in management of
ischemic heart disease and heart failure that can really help us
highlight some of these disparities in healthcare between men and women.
Scott Webb: I'm wondering, doctor, I wanted to just jump in here.
Because I've spoken with other experts what I've heard is, and I'm just a lay
person here, so you know, bear with me.
But what I've heard basically is that oftentimes it is the presentation,
That is different between men and women in terms of heart.
Issues, heart attacks, whatever it might be.
And I'm just wondering, is that a part of the reason, is it just
it doesn't present the same way?
It isn't as obvious when women, the symptoms they're experiencing are heart
related or cardiovascular related.
Dr. Stephen Cook:
So That is a great myth that I would like to debunk
Scott Webb: Okay, good.
Dr. Stephen Cook:
it's, it's interesting when you think about, diagnosis
of ischemic heart disease.
You know, many people believe that women have atypical symptoms
when it comes to chest pain.
Scott Webb: Okay.
Dr. Stephen Cook:
At the time of presentation, women and men are equally likely to report chest pain.
However, women are more likely to endorse additional symptoms.
May complicate the clinical picture and therefore I believe
that this leads to delay.
In presentations to the emergency department, there's been studies
that show that women are less likely to undergo cardiac catheterization.
In addition, women are less likely to receive optimal medical
therapy for myocardial infarction as well as secondary prevention.
So as a result of all of these factors, women with acute coronary syndrome.
Often lead to worse in hospital outcomes than men, including a higher risk
for heart failure, shock, and stroke.
So I think it's, you know, if we continue to perpetuate this myth that women should
present with stomach discomfort or GERD like symptoms or atypical pain, it's
taking the right history and understanding that women are just as likely to
show up with chest pain as men and providing them with the same exact care.
And not being kind of going through this, and taking off our blinders
that, you know, women and men should not be receiving the same
care is incredibly important.
Scott Webb: Yeah, I'm wondering Doctor then, is one of the answers or one of the
solutions to this problem, is it better or more community outreach, better education
efforts, like what we're doing today, podcasts like this and other things?
Is that one of the keys, , to solving this?
Dr. Stephen Cook:
Yeah, This is a very challenging problem to kind of address.
You know, one of the, probably the most important thing to address is
recognizing sex specific risk factors.
I think that compared to men, and we've talked about this already,
women have very specific sex specific risk factors that are deeply
interconnected throughout their lifespan.
So for example, early menopause are highly associated with a higher
risk of coronary disease, stroke.
Heart failure.
Again, the mechanisms driving for these risks are deficiencies
in endogenous hormones.
We talked about adverse pregnancy outcomes.
We talked about hypertensive disorders of pregnancy, gestational diabetes.
If you don't take the time to understand this history, you're gonna completely miss
patient's that are at a higher risk for the development of cardiovascular disease.
And I think that, many cardiologists are unaware of these risk factors, and I
think it takes people who are interested.
Women's health and I think it takes people who are advocates for people
who are interested in women's health and we have more people who are trained
in this subspecialty of cardiovascular medicine, This is what's gonna change
the tide for people who are being more aggressive with taking care of women in
general, equal to or not better than men.
Scott Webb: Right.
Right.
That, that's well said.
Equal to, but not better.
Just equal, right?
Yeah.
So then million-dollar question doctors, we get close to wrapping up here is
how can healthcare systems do better?
What are some of the things that they need to know in order, you
know, to improve care, diagnosis, treatment outcomes, all that.
Dr. Stephen Cook:
You know, it's multi-pronged, right?
I think that, and I think This is already starting to happen.
It has to happen, you know, at an academic level, right?
, In academics now There are institutions that are actually, have
formalized women's cardiovascular.
Fellowship training programs that are uniquely tailored to address the unique
aspects of women's cardiovascular health.
And I think that will certainly pull the trigger to kind of help
identify, what are barriers?
Why are we not, caring for women similarly to men?
You know, I think another big problem is really diversification
of the workforce there.
When you compare the number of women compared to men.
In the cardiovascular workforce, it's much less, and I think This is why there's
been a such a drag in even enrolling women into cardiovascular research studies.
So I think Those are two things that'll hopefully change the tide in the future.
I think at an institutional level, it's identifying barriers to, you know,
getting women into the cardiology clinic.
Is there transportation barriers?
Is there childcare barriers?
Are there language barriers?
So there's a lot of things that could happen at an institutional
level as well to make it easy for women to receive cardiovascular care.
Scott Webb: It's so interesting and I just am listening to you and I'm thinking
about the women in my life, right?
My mom, of course, my wife, my daughter, and just wanting, as you
say, like equal treatment for all.
Not better, just equal.
And, education seems like such a big part of this on so many levels.
I'm glad we did this today.
I appreciated having you on both times.
I'm sure we'll speak again in the future.
So thank you so much.
Dr. Stephen Cook:
It's my pleasure.
Scott Webb: And to learn more, visit franciscanhealth.org
dot org slash her heart.
Host: And if you found this podcast helpful, please share it on your
social channels, and be sure to check out the full podcast library
for additional topics of interest.
This is the Franciscan Health Doc Pod.
I'm Scott Webb.
Stay well, and we'll talk again next time.