Female veterans who have gone through the Veterans Administration (VA) system to receive cardiac catheterization tend to be younger, more obese, more depressed and more likely to suffer from post-traumatic stress disorder (PTSD) than their male counterparts, according to a new study published in an American Heart Association (AHA) journal.
The study resulted from the national Veterans Administration Clinical Assessment Reporting and Tracking (CART) analysis of veterans who had received cardiac catheterization in the VA system. The median age for female veterans having the heart test was about 57, six years younger than the median age of male veterans.
In general, women are underrepresented in heart disease research, according to the AHA. Because of this gap, doctors lack important information about how women might respond differently to heart disease, have different symptoms, and require different diagnostic approaches and treatments.
In the past decade, however, the number of women being cared for by veteran affairs facilities has doubled, offering a unique opportunity to observe the heart health of female veterans. The findings reveal that female veterans face a different set of circumstances and symptoms compared to both male veterans and women who are non-veterans.
Although chest pain was a common reason for women to undergo cardiac catheterization (a medical procedure to diagnose and treat some heart conditions), doctors were less likely to find blockages in women’s arteries that could lead to a heart attack or stroke, said lead study author Melinda B. Davis, M.D., cardiologist at the University of Michigan Frankel Cardiovascular Center and the VA Ann Arbor Healthcare System.
The findings shed more light on reasons for chest pain in women veterans: often the result of stress-induced heart disease and coronary microvascular disease — spasms in the walls of very small arterial blood vessels which can lead to severe and long-lasting angina, or chest pain.
Additional findings from the national study of nearly 86,000 veterans, including 3,181 women:
- Women veterans were younger and had fewer heart disease risks than men veterans;
- Women veterans had higher rates of depression (55.3 percent vs. 31.4 percent) and PTSD (20 percent vs. 16 percent) than men veterans, highlighting mental health as a potential risk factor for heart disease;
- Women veterans had similar one year outcomes after the cardiac catheterization. They were less likely to leave the hospital with heart medications even if doctors found acute disease.
“Investigating the reasons behind these findings and developing effective approaches based on those insights could potentially help address the gender differences in heart disease we see in the general population,” said senior study author Claire Duvernoy, M.D., chief of cardiology at VA Healthcare Ann Arbor and cardiologist at the University of Michigan Cardiovascular Center.
The findings are published in the journal Circulation: Cardiovascular Quality and Outcomes. A portion of the March issue is dedicated to research in women.
“Dedicating a women’s themed section in this research journal offers the latest in quality studies on women and reminds us about the importance of this area of investigation,” said Harlan Krumholz, M.D., S.M., editor of the journal, director of the Center of Outcomes Research and Evaluation at Yale-New Haven Hospital and a professor in Yale’s schools of medicine and public health.
“In the future, if we really want to answer all the questions we have about gender differences, then we need studies that are large enough, focused enough, and with the intent from the start to illuminate the issues around sex differences,” he said.