By Dr. Janet Matthews
During my medical career I have had several men joke about coming to see me for “gynecologic” exams. One man in particular, the husband of a close friend and a good friend himself, refers to me as “his gynecologist.”
I usually reply that the men should climb onto my exam table, stirrups and all, just to get a feel for what we women put up with. No man has yet taken me up on that, but even if a brave soul did so we all know that it just wouldn’t be the same. Pap smears and childbirth are big gender dividers.
Medical science has been scrambling during the last decade or so to catch up with research disparities along that gender divider.
Research in women has long taken a back seat to research in men, often for no more sinister reason than that women have the potential for pregnancy. No researcher wants to risk exposing an unborn infant to uncertain hazards, and this risk has often been avoided by limiting research to males.
Results from studies done on male populations have been assumed to apply to both genders, often wrongly so.
One area in which gender differences have been found to cause differences in research outcomes is the study of cardiovascular disease. We've always known that women get heart disease at different rates than men, but we’ve assumed that other aspects of the disease were the same for both sexes.
We have even overlooked or ignored the statistics which tell us that the leading cause of death for women is not cancer, but heart disease. That’s right, heart disease kills more women than all forms of cancer combined.
So how does heart disease in women differ from the problem in men? One important difference is that the symptoms may be different, and may not match up with what medical providers have traditionally been taught to associate with heart disease.
Women can experience severe heart attacks with out ever having the usual central or left-sided chest pain with radiation to the left arm or jaw. That's the traditional scenario of a male with cardiac disease, but in women the symptoms may be more subtle or varied.
Health care providers are also more likely to look for alternative explanations for women’s symptoms. Heart disease isn't usually the first item on a mental list of possible diagnoses, and so testing for it sometimes isn't started as quickly as it would be for a man.
Risk factors for heart disease in women are also somewhat different than in men. We all know that high cholesterol levels are associated with a higher risk for heart disease, but it’s important to know that the breakdown of different types of cholesterol is more important for women than for men.
Total cholesterol can be divided into LDL, or bad cholesterol and HDL, or good cholesterol. For women the number for the total is not as important as the number for the HDL.
Even with a normal level of total cholesterol, women may be at risk for heart disease if the HDL level is too low. Conversely, a women with a higher than normal total cholesterol may be at very low risk if her HDL is high.
Where does that leave you as a women who wants to decrease risks and avoid heart disease? Fortunately, the advice for basic good health still applies: eat right, maintain a healthy weight, don't smoke, and exercise at least 30 minutes a day on most days. Want more specifics? Tune in here in two weeks for more, or check out the American Heart Association Web site at www.americanheart.org.
Dr. Janet Matthews is with The Women’s Center, a service of Muskogee Regional Medical Center, 687-3050.
