Daily aspirin does not appear to protect healthy women against heart attacks, despite many studies that show it may benefit men as much as stopping smoking or lowering their LDL cholesterol and blood pressure. Why, then, do many doctors pay so little attention to preventing heart attacks in women?
One explanation is that women and doctors alike still believe that heart disease is a "man's disease," despite the fact that as many women as men die of coronary disease.
Cardiologists at Johns Hopkins have recently discovered another possible explanation. Physicians commonly use a formula called the Framingham risk equation, based on the presence and absence of heart risk factors, to estimate a patient's likelihood of having a heart attack in the next 10 years. Patients who are at high risk of having a heart attack are aggressively treated to control blood pressure and LDL cholesterol levels.
But in a study of 2447 middle-aged women with no symptoms of heart disease or diabetes, researchers at Johns Hopkins determined that a coronary artery calcium score -- a measure of atherosclerotic plaques in the coronary arteries obtained with electron-beam computed tomography (EBCT) -- may be a better predictor of heart attack risk in women. They found that the Framingham risk equation actually classified the majority of women (84 percent) who had high calcium scores as low-risk. These findings suggest that the Framingham risk equation should not be used to decide what preventive measures, if any, to recommend or prescribe for women.
A woman with high LDL cholesterol, hypertension, or a positive family history of coronary heart disease might ask her doctor about an EBCT test if the doctor is reluctant to recommend aggressive measures to prevent a heart attack.