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May
26,
2009 -- 12:05am EDT
Women's Heart Health at Stanford
 In
my
recent interview with Dr. Jennifer Tremmel, Clinical Director
of Women's
Heart Health at Stanford, we discussed some of the ways in which
heart disease manifests itself differently in women than in men, and
how treatment for women has been skewed by the historical context.
As Dr. Tremmel noted:
In cardiology, we started
doing research back in the late 40's early 50's -- predominately
on men, so women made up only about a quarter of the patients
in most trials. And we've been applying that data to both sexes,
assuming it would be fine. But men's outcomes have improved
over time and women's have not, until very recently -- so one
would theorize that applying the same data to both men and
women is not the way to go.
About a decade ago we started to have more
data coming out about women and how they differ from men
and how we might treat them differently, approach them differently
so they would have better outcomes. And this applies to everything.
How risk factors impact the sexes differs, how women present
with coronary disease differs from men, what tests are more
accurate in women differs from men, and how they do with
our procedures, PCI, CABG, differs -- they tend to have worse
outcomes, although that is improving.
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One specific area where Dr. Tremmel recently has
made changes, and this was the focus of our interview, was in the
vascular access
site she uses in catheter-based procedures. She notes that women
have higher rates of bleeding complications than men when the femoral
(groin) access site is used -- and it is used in more than 90%
of procedures in the U.S. This increased bleeding risk prompted
Dr. Tremmel to examine, learn and utilize the radial (wrist)
approach to angioplasty. She now tries to
perform 100% of her procedures
through the wrist and, as a result, has had virtually no complications.
More information about Women's Heart Health at
Stanford can be found here. My full interview with Jennifer
Tremmel can be found here.
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