[Congressional Record Volume 140, Number 41 (Friday, April 15, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: April 15, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
             WOMEN AND HEART DISEASE: A HISTORY OF INEQUITY

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                        HON. PATRICIA SCHROEDER

                              of colorado

                    in the house of representatives

                        Thursday, April 14, 1994

  Mrs. SCHROEDER. Mr. Speaker, I am distressed by an article in the 
April 5, 1994, health section of the Washington Post telling how women 
were slighted in a new heart study.
  The article relates how researchers at St. Louis University School of 
Medicine found that women who scored poorly on a standard treadmill 
stress test were only half as likely as their male counterparts to be 
referred for more evaluation. And that was true even when the women had 
a greater number of predisposing cardiac problems.
  The Post article also refers to several recent studies showing that 
among adults already diagnosed with heart disease, women got less 
aggressive treatment than men.
  This new report documenting the unequal treatment women get in our 
health care system comes as the American Heart Association is reminding 
the Congressional Caucus for Women's Issues that cardiovascular 
diseases, including heart attack and stroke, remain the No. 1 killer of 
American females. Heart disease kills 240,000 American women every 
year, while stroke claims another 88,000, according to the association.
  The Heart Association also draws attention to an article in the 
October 3, 1993, New York Times Magazine called ``Are Women's Hearts 
Different: Or Are They Treated Differently?'' The article tells how 
doctors often refer women with chest pains to psychotherapists, while 
they send men with chest pains for medical tests.
  Even when women are tested, the tests aren't suited to many of their 
heart problems, according to the article. And when they do get 
treatment, that treatment is often less aggressive than that given to 
men.
  I feel like a broken record on this issue of health care equity for 
women, but lately it seems as if the bad news has come in waves. If 
we're not breaking the news to women about fraud in breast cancer 
research, we're trying to help them deal with conflicting signals or 
when to get mammographies. If we're not helping them grapple with 
Government and researchers' failure to expeditiously warn them about 
the risks of taking the cancer drug tamoxifen, we're telling them that 
many of the diseases affecting them are often mis-diagnosed.
  All of this is set against an historical backdrop of women being 
excluded from Government-sponsored clinical trials and drug studies, 
which we are in the process of correcting.
  We women are not going to let up on our demands for health care 
equity. I trust my colleagues will keep this in mind as we try to 
reform the system.
  I take this opportunity to insert the Post article into the 
Congressional Record.

                [From the Washington Post, Apr. 5, 1994]

               Women in Heart Study Slighted in Follow-Up

                            (By Rick Weiss)

       Women who score poorly on a standard treadmill stress test 
     are only half as likely to be referred for further evaluation 
     as are their male counterparts, even when the women have a 
     greater number of predisposing cardiac problems, a new study 
     has found.
       The gender-based difference in care may make a deadly 
     difference. Compared to men in the study, the women were 
     twice as likely to have died or had a heart attack within two 
     years after taking the test.
       Several recent studies have shown that among adults already 
     diagnosed with heart disease, women get treated differently 
     from men. In one study of adults who had experienced a heart 
     attack or suffered from periodic angina attacks, women were 
     up to 28 percent less likely than men to get an arteriogram, 
     the most definitive measure of heart vessel health. Another 
     study found that among adults with heart disease, men are 
     almost twice as likely as women to get ``revascularized,'' a 
     medical treatment to reopen their arteries.
       Now comes a report of differences in care among men and 
     women not known to suffer from heart disease but with enough 
     early symptoms to get referred for preliminary tests. Leslee 
     J. Shaw and her colleagues at St. Louis University School of 
     Medicine tracked the medical care and outcomes of 850 adults 
     who came to a clinic for a stress test, in which a person's 
     heart is monitored while on a treadmill.
       Approximately equal numbers of men and women got abnormal 
     scores on the test. But 62 percent of the men and only 38 
     percent of the women were referred for additional evaluation. 
     Moreover, twice as many men as women went on to get 
     revascularization.
       The women in the study had a greater frequency of abnormal 
     chest pain, longer duration of symptoms before testing, 
     higher blood pressure, higher cholesterol levels and a 
     greater number of risk factors for heart disease overall.
       Two years later, differences persisted in terms of 
     mortality. Five percent of the women and only two percent of 
     the men had experienced heart attacks during that period. And 
     two percent of the women had died of heart disease, compared 
     to one percent of men. When the researchers analyzed each 
     person's care and fate, it was those who had received the 
     least follow-up care who were most likely to have had a heart 
     attack or other cardiac problem.
       The researchers note that upon initial testing, the men 
     were more likely to show problems in several of their 
     coronary arteries, while the women were more likely to show 
     problems in only one, perhaps explaining the greater 
     attention given to men. The study, which appears in the April 
     1 issue of the Annals of Internal Medicine, sought only to 
     see what doctors do, not why they do what they do, so it 
     included no questions about how decisions were made. 
     Cardiologist Douglas Miller, a coauthor on the paper, said 
     there is a perception among doctors that abnormal stress test 
     results in women are often not accurate. In fact, women are 
     more likely to get ``false positive'' results, he said, but 
     the study shows that women would benefit if both they and 
     their doctors took abnormal results more seriously.
       That, the researchers conclude, remains to be measured in 
     another study.

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