he Heart Institute of Winthrop-University Hospital was one of the first hospital Cardiology programs in the nation to recognize and respond to the unique cardiovascular needs of women, providing gender-specific approaches to the prevention, diagnosis, and treatment of cardiac disease.
Drawing upon the wealth of knowledge and experience in Winthrop's Divisions of Cardiology, Endocrinology, and Reproductive Medicine (part of the Department of Obstetrics/Gynecology), the Hospital's triple-pronged approach to women with cardiovascular disease addresses the needs of postmenopausal women, who are most likely to have cardiovascular disease, while also providing preventive care, monitoring, and treatment of younger women who present with the earlier danger signs and symptoms of cardiovascular disease. These signs include overweight, physical inactivity, hyperlipidemia (high blood cholesterol), and hypertension (high blood pressure).
At Winthrop, considerable research is focused on the ways in which cardiovascular disease in women must be diagnosed and treated differently from the "same" disease in men. Richard M. Steingart, MD, Chief of Winthrop's Division of Cardiology, has made Winthrop a leader in raising the consciousness of both the community and the nation about cardiovascular disease as a women's health issue - and in identifying the deficiencies in existing programs and research.
"Winthrop was largely responsible for making constructive changes in the delivery of cardiovascular care for women, and in formulating programs to heighten the awareness of women and their primary care physicians of the risks, particularly after menopause," notes Dr. Steingart.
"The techniques for eliciting symptoms differ in women," he adds. "The assessment draws from the patient interview and the physical examination, and is followed with the proper selection and interpretation of diagnostic tests, to firm up a diagnosis and subsequently develop the appropriate diagnostic treatment plan."
At Winthrop, the Women's Cardiovascular Program includes a complete program of medical treatment, including rehabilitation, wellness, drug and vitamin therapy, and, as needed, interventional cardiology and surgery.
Beyond the initial interview, non-invasive cardiological methods are used in select patients, to isolate and better characterize problems, relying on specific protocols to accurately diagnose each woman's condition. Tests could include monitored treadmill testing, nuclear scanning, and stress echocardiogram - each test gender specific and individually tailored. Florence Prigent, MD is Co-Director of Winthrop's Nuclear Cardiology diagnostic program.
The Role of Hormone Replacement Therapy
Winthrop's Cardiology Division works closely with the Divisions of Endocrinology and Reproductive Medicine in the formulation of appropriate preventive strategies. Through collaboration with Magdalen Hull, MD, Director of Reproductive Medicine, Department of Obstetrics/Gynecology, and John F. Aloia, MD, Chairman of Medicine/Chief of the Division of Endocrinology, cardiologists draw from the rich resources of experts in the treatment of osteoporosis and other postmenopausal conditions. Knowing that hormone replacement therapy (HRT) can benefit the cardiovascular system as well as the skeletal system, individualized treatment programs are recommended to appropriate patients, who are fully informed about the potential benefits and risks.
Women and Angioplasty
The original development and testing of technology associated with angioplasty during the l970's was based on studies with male subjects - with a resulting gap in success rates between male and female patients. Female patients had poorer outcomes. "However, beginning in the early l990's, this gap has narrowed significantly," declares Dr. Steingart. "In recent mortality statistics published by the Department of Health, the patient's sex is no longer a consideration."
As Winthrop is an internationally known medical teaching institution, female cardiology patients are eligible to participate in Winthrop's research trials. "Winthrop was among the international leaders in ensuring that women were adequately represented in clinical trials," Dr. Steingart affirms. "Previous to this proactive stance, trials were developed solely with male participants, which left medical science without a real understanding of how women would react differently to therapies."
RhVEGF and SCDHeft
Women patients are eligible to participate in the Winthrop Heart Institute's two current trials - rhVEGF and SCDHeFT. To discuss your participation, please call Dr. Steingart at 516/663-2046.