THE WOMEN AND HEART DISEASE AWARENESS CAMPAIGN:

Awareness + Fear + Drugs

 

 

Heart disease is the number one killer of women.

 

½ million women in the U.S. die each year of cardiovascular disease—higher than the number of men and the next seven causes of death in women.

An American woman dies every two minutes of heart disease.

They're scaring us with statistics again. These statistics were quoted recently in the media because February was American Heart Month aimed at increasing women's awareness of their risk of developing heart disease. The campaign was launched by First Lady Laura Bush who encouraged women to wear a red dress on February 6 while the fashion industry announced that it would send a traveling fashion show with models wearing red dresses to five major cities—all in the cause of giving “women a personal and urgent wake-up call about their risk for heart disease.”

Apparently, women are woefully unaware of heart disease. A survey cited by the campaign found that only 9% of women, aged 45 to 64 years, named heart disease as the condition they most fear, while 61% named breast cancer. In a major effort to raise the fear level, the heart disease awareness campaign is following the path of the breast cancer awareness campaign, which in its early days told women that one in eight would get breast cancer. This statistic successfully raised fears, especially when no one explained that breast cancer is overwhelmingly a disease of older women and that one in eight women get breast cancer only if they live to be 90. Breast cancer is the leading cause of death for women, aged 40-44 years. As intended, this particular statistic got many women in their 40s to make a mammography appointment. It seemed to be in no one's interest to explain that women in this age group do not have a high rate of death from anything.

Here we go again. Yet another disease awareness campaign, complete with its own pin—a tiny red dress. The first thing to be skeptical about in any disease awareness campaign are the statistics showing how widespread the problem is. Yes, heart disease is the number one killer of women, but the critical issue is the number of women who die prematurely of heart disease. Taken from that perspective, heart-related annual deaths drop from the above-quoted ½ million to 50,000 women under the age of 65 years. Or put another way, nearly 80% of the heart-related deaths in women occur over the age of 75.

After age 50, women begin to develop and die of heart disease at a rate equal to that of men. This statistic is only somewhat accurate because it fails to convey the fact that women are a good 15 years older by the time equality kicks in. No doubt, women in early middle age would not be scared enough if they were told that the average age for a first heart attack is about 70 years .

The next thing to be skeptical about in any disease awareness campaign is the sponsor. Ask yourself who profits from raising fear of a particular disease—and then follow the money. American Heart Month was sponsored by two government agencies: the National Heart, Lung and Blood Institute (NHLBI) and the National Institutes of Health. That's what the Web site says. But who funds the campaign? You'll find the answer on the NHLBI Web site, which lists another sponsoring organization called WomenHeart: National Coalition for Women with Heart Disease. The corporate funders of this group include PHARMA, the trade association for the pharmaceutical industry, and ten companies that make heart drugs or devices. (Breast Cancer Awareness Month is funded by AstraZeneca, makers of the world's best-selling anti-breast cancer drug, tamoxifen.)

One might ask what could be possibly be the downside of a campaign that encourages healthy symptom-free women between the ages of 40 and 60 years to ask their doctors about their personal risk factors for heart disease. Here's one: It is in the pharmaceutical industry's interest to make women and doctors think that heart disease occurs right after menopause when estrogen levels decline—that's a big reason why estrogen “replacement” therapy became so widely prescribed to women in early middle age as a heart disease preventive.

Now the pharmaceutical industry needs another drug that healthy women can take for the rest of their lives, and there are plenty of choices, ranging from aspirin to cholesterol-lowering drugs. Women are underrepresented in the statin and aspirin clinical trials, making up less than one-third of all participants. This leaves a crucial unanswered question: Do the benefits outweigh the risks of these drugs for healthy but high-risk women?

Increased awareness of any disease inevitably results in drawing broad boundaries around who is at high risk. Heart disease awareness is likely to funnel healthy women to inappropriate and inaccurate testing that, in turn, will lead to inappropriate lifelong drug therapy. That's why you see so many drug company-sponsored ads that do not mention a drug but simply tell consumers to ask their doctors about having a cholesterol-screening test or a bone-density test.

What's more, the standard non-pharmacologic recommendations to high-risk women are already well known: lose excess weight; get blood pressure* under control; exercise regularly; stop smoking; etc. Following these recommendations “will reduce the risk of heart disease as well as the risk of diabetes which is also a risk for heart disease,” said Judith Walsh, MD, associate professor of clinical medicine at the Women's Health Clinic Research Center, University of California at San Francisco, in a telephone interview. “The heart disease awareness campaign should focus women on a healthy lifestyle,” she said.

Asked about the likely possibility that doctors may instead focus on cholesterol testing, Dr. Walsh responded, “The issue with cholesterol is that it is a number that needs to be interpreted within the context of other heart disease risk factors. If a woman is young and otherwise healthy and has a high cholesterol, her overall risk for heart disease is still very very low,” she said, “but as a woman gets older—reaching her 70s—and has high blood pressure and diabetes and then has high cholesterol—that's different.”

A pharmaceutical industry-fueled awareness campaign is not likely to give more than lip service to lifestyle changes; nor will it look at factors outside the medical care system's purview. Arguably, poverty is an important risk for premature deaths from heart disease, one that goes unmentioned in the awareness campaign. Conversely, low rates of heart disease are associated with white women and women of affluence. A traveling fashion show might very well be targeting the wrong group of women.

 

*A Cochrane review of all trials in which women with hypertension had been randomly assigned to a drug or a placebo came to this conclusion: drug treatment for white women with high blood pressure between the ages of 30 and 54 years provides no benefit or harm.

 

Maryann Napoli, March 2004