March 2005 Volume 32 No. 3
Clinic targets often elusive diagnosis:
women’s heart disease

Diagnosing and treating women who might otherwise slide under the radar screen is the goal of Stanford Hospital’s quickly growing women’s heart clinic, which opened less than a year ago, said clinic director Jennifer Tremmel.

The specialized clinic, Women’s Heart Health, operates one day a week at SHC and twice a month at a clinic in Monterey, serving about 150 patients, said Tremmel an instructor of cardiovascular medicine.

As part of a growing trend across the nation to set up cardiology programs for women, the new clinic is designed to reach out to those who for a variety of reasons — less aggressive care, differing risk factors, gaps in research — are getting missed.

“We can find out what’s wrong with these patients,” Tremmel said. In addition to treating women, she is conducting an American Heart Association-funded study on sex differences in cardiovascular disease.

While women are generally more likely to worry about breast cancer, the reality is that cardiovascular disease kills almost twice as many American women as all cancers put together. It’s the largest single cause of mortality among women, accounting for 38 percent of all deaths among females, according to the American Heart Association.

And yet, consistently, heart disease in women is misdiagnosed and under-treated.

“The sex gap in cardiovascular disease hit its peak in 1999 and is finally getting some attention,” Tremmel said. More women than men have died of cardiovascular disease in every year since 1984. Exactly why this is happening remains unclear.

Most disturbing, women have not had the decrease in death rates from heart disease that men have continued to experience over the past few decades.

Tremmel said that women tend to complain of symptoms beyond the universal signs of heart disease. More often women may report back, neck or arm pain as well, and they often report getting their symptoms when under emotional stress.

“When women come in and list off several symptoms, it’s confusing to know what’s wrong with them,” Tremmel said. “In the past we called them atypical, but I see so many women with these symptoms, they’re now typical to me.”

—Courtesy Stanford School of Medicine
Office of Communication and Public Affairs