Hello, His and Her Healthcare
Medicine now recognizes that women are different
A man's heart is not a woman's heart; his pain is not her pain. And a standard response to a common medical complaint might work for him--and kill her. Just ask Denise Weiss, who, at 42, was struck by a sensation akin to someone's hand "squeezing the inside of your chest." A trip to the emergency room near her Beverly Hills, Calif., home found nothing, and a subsequent angiogram was clear. It wasn't until 18 months later, when she found a doctor attuned to heart disease's different faces, that she was diagnosed with microvascular dysfunction--a dangerous constricting or clogging of the heart's tiniest arteries that disproportionately affects women and can lead to a heart attack.
Only recently has medicine begun to acknowledge that the wondrous differences between men and women go well beyond size and body parts and a willingness to ask for directions. But things are changing fast now--and the implications for diagnosing, preventing, and treating disease are potentially huge. "The name of the game is to compare men and women and to define the unique characteristics of both," says Marianne Legato, founder of Columbia University's Partnership for Gender-Specific Medicine. Understanding the role that genetics and hormones play in the way illness develops and responds to treatment has obvious benefits for women's quality and length of life, and implications for men's health, too. Might breast cancer and osteoporosis act differently in them?
Cardiac health, traditionally considered a man's concern, has been one of the most fruitful areas of research and one of the most urgent. Heart disease kills more women than all types of cancer put together; in diabetic women, the risk of coronary artery disease rises sixfold, while in diabetic men, it doubles. Yet when women show up with symptoms that don't conform to the male standard--nausea, sweating, or shortness of breath are often female signals of heart attack, for example, rather than the classic burning pain in the chest or arm--their worries are often dismissed. Even when they do report similar symptoms, the complaints may be ignored: One recent European study found that women are less likely than men to receive treatment for angina, the chest pain that signals heart trouble.
Her heart. Yet we now know that profound differences characterize heart disease in men and women, says Mariell Jessup, medical director of the heart failure and transplant program at the Hospital of the University of Pennsylvania. The way women's hearts respond to high blood pressure--they develop thicker walls than men's hearts do, which make the heart less able to relax--puts women at higher risk of heart failure, for example. And, like Denise Weiss, women are far more likely than men to have coronary microvascular dysfunction even as their major arteries remain clear of fatty plaques. Indeed, some cardiologists think women should be screened using more sophisticated tests than angiograms. "It's possible that this should become standard testing,"says Weiss's doctor, Noel Bairey Merz, medical director of women's health at Cedars-Sinai Medical Center in Los Angeles and chair of a large study tracking women with heart problems.