The greatest threat to women's health

Abstract

Which disease kills the greatest number of women worldwide? Judging by the attention given to the disease in newspaper headlines and media campaigns, many women and men in developed nations might answer breast cancer. Others might hazard a guess at malaria, tuberculosis, or HIV/AIDS. They would all be wrong. In fact, heart attacks and stroke kill twice as many women as all cancers combined. Women are four times more likely to die from coronary heart disease than from breast cancer. Moreover, contradicting conventional wisdom, women are more likely to die from cardiovascular disease than men.Cardiovascular disease kills 16·5 million annually, of whom 8·6 million are women. According to the latest findings from WHO's MONICA (MONItoring CArdiovascular disease) project, one-third of global deaths are due to cardiovascular disease (defined as coronary heart disease, cerebrovascular disease, hypertension, heart failure, or rheumatic heart disease). Most of these global deaths are in countries with low or medium incomes. By 2010, cardiovascular disease will be the leading cause of death in developing countries. And many of the 20 million survivors of heart attacks and strokes every year require costly longterm care. Yet more than half of all deaths and disability from heart disease and stroke can be prevented.The MONICA findings, released to coincide with World Heart Day on Sept 28—which had the theme “Women, heart disease and stroke”—are the result of the largest ever global collaboration on heart disease. MONICA, conceived in 1979, involved teams (38 populations, 21 countries) studying heart disease, stroke, and their risk factors from the mid-1980s to the mid-1990s, and is instrumental in informing policy makers about prevention strategies and the effects of treatments.So how can the growing epidemic of cardiovascular disease in women be stopped? Prevention of more than half of all deaths and disability from the disease is possible. But getting women to stop smoking, eat healthily, drink alcohol only in moderation, lose weight if appropriate, and take regular exercise involves changing behaviours that are often ingrained from childhood. Raising awareness of cardiovascular disease in women will take national campaigns to include antenatal care, schools, and the mass media. Promoting images of women with cardiovascular disease in television dramas (men are almost always portrayed as the victims of heart disease), newspaper articles, and magazines would help.It is too easy, though, to blame others and to ask others to change. Breast cancer researchers are very successful at promoting public awareness of their field as the media hype around the launch of a 10-year trial of anastrozole demonstrated last week. Cardiovascular disease researchers, who have largely ignored women in previous decades, have lessons to learn. Moreover, in a survey of 1029 women over 16 years carried out for the British Heart Foundation, four out of five women had never discussed heart disease with their primary-care practitioner or practice nurse. Two-thirds of women over 65 years had never had a consultation with a doctor or nurse about heart disease, even though it is these older women who are at greatest risk. In another survey (Global Reality of Attitudes on Stroke Prevention and Hypertension— GRASP), most of the 825 primary-care physicians from 11 countries mistakenly thought that men were more likely to die from stroke than women. Doctors can do much more to promote the lifestyle changes their patients need, and to ensure that women, as well as men, have regular blood-pressure checks and are invited to discuss what they can do to reduce risks. If more evidence is needed, a cohort study in this week's journal (p 1178) shows that weight control throughout life is crucial in preventing raised blood pressure in middle age, while the seminar on stroke (p 1211) usefully summarises the facts on risk factors.Translating evidence from research into clinical practice is the theme of a three-part series that begins this week (p 1170 and p 1225). The barriers to implementing change in clinical practice are, without doubt, substantial, and changing doctors' behaviour is no easier than changing women's or men's lifestyle choices. Advising women, as well as men, about their risks of cardiovascular disease should, we urge, be mandatory for all primary-care practitioners. Which disease kills the greatest number of women worldwide? Judging by the attention given to the disease in newspaper headlines and media campaigns, many women and men in developed nations might answer breast cancer. Others might hazard a guess at malaria, tuberculosis, or HIV/AIDS. They would all be wrong. In fact, heart attacks and stroke kill twice as many women as all cancers combined. Women are four times more likely to die from coronary heart disease than from breast cancer. Moreover, contradicting conventional wisdom, women are more likely to die from cardiovascular disease than men. Cardiovascular disease kills 16·5 million annually, of whom 8·6 million are women. According to the latest findings from WHO's MONICA (MONItoring CArdiovascular disease) project, one-third of global deaths are due to cardiovascular disease (defined as coronary heart disease, cerebrovascular disease, hypertension, heart failure, or rheumatic heart disease). Most of these global deaths are in countries with low or medium incomes. By 2010, cardiovascular disease will be the leading cause of death in developing countries. And many of the 20 million survivors of heart attacks and strokes every year require costly longterm care. Yet more than half of all deaths and disability from heart disease and stroke can be prevented. The MONICA findings, released to coincide with World Heart Day on Sept 28—which had the theme “Women, heart disease and stroke”—are the result of the largest ever global collaboration on heart disease. MONICA, conceived in 1979, involved teams (38 populations, 21 countries) studying heart disease, stroke, and their risk factors from the mid-1980s to the mid-1990s, and is instrumental in informing policy makers about prevention strategies and the effects of treatments. So how can the growing epidemic of cardiovascular disease in women be stopped? Prevention of more than half of all deaths and disability from the disease is possible. But getting women to stop smoking, eat healthily, drink alcohol only in moderation, lose weight if appropriate, and take regular exercise involves changing behaviours that are often ingrained from childhood. Raising awareness of cardiovascular disease in women will take national campaigns to include antenatal care, schools, and the mass media. Promoting images of women with cardiovascular disease in television dramas (men are almost always portrayed as the victims of heart disease), newspaper articles, and magazines would help. It is too easy, though, to blame others and to ask others to change. Breast cancer researchers are very successful at promoting public awareness of their field as the media hype around the launch of a 10-year trial of anastrozole demonstrated last week. Cardiovascular disease researchers, who have largely ignored women in previous decades, have lessons to learn. Moreover, in a survey of 1029 women over 16 years carried out for the British Heart Foundation, four out of five women had never discussed heart disease with their primary-care practitioner or practice nurse. Two-thirds of women over 65 years had never had a consultation with a doctor or nurse about heart disease, even though it is these older women who are at greatest risk. In another survey (Global Reality of Attitudes on Stroke Prevention and Hypertension— GRASP), most of the 825 primary-care physicians from 11 countries mistakenly thought that men were more likely to die from stroke than women. Doctors can do much more to promote the lifestyle changes their patients need, and to ensure that women, as well as men, have regular blood-pressure checks and are invited to discuss what they can do to reduce risks. If more evidence is needed, a cohort study in this week's journal (p 1178) shows that weight control throughout life is crucial in preventing raised blood pressure in middle age, while the seminar on stroke (p 1211) usefully summarises the facts on risk factors. Translating evidence from research into clinical practice is the theme of a three-part series that begins this week (p 1170 and p 1225). The barriers to implementing change in clinical practice are, without doubt, substantial, and changing doctors' behaviour is no easier than changing women's or men's lifestyle choices. Advising women, as well as men, about their risks of cardiovascular disease should, we urge, be mandatory for all primary-care practitioners.