Stanford Medicine Newsletter Updates For the Local Community

Clinic addresses disparities in women’s heart health

Spring 2008

Play eases the anxiety of Bernard Dannenberg's young patient.

Jennifer Tremmel, MD, is the director of the Women's Heart Health Clinic at Stanford Hospital.

Diagnosing and treating women who might otherwise slide under the radar screen is the goal of Stanford Hospital’s quickly growing Women’s Heart Health Clinic, which opened less than a year ago.

The new clinic is designed to reach out to women whose conditions, for a variety of reasons—less aggressive care, differing risk factors, gaps in research—are getting missed.

The clinic is also part of the Stanford Cardiovascular Institute’s overarching goal to address issues of women’s heart health through patient care, education and research in the areas where huge gaps in knowledge remain.

“We can find out what’s wrong with these patients,” said clinic director Jennifer Tremmel, MD, an instructor of cardiovascular medicine at the School of Medicine. “We can diagnose them, we can treat them. Most physicians are going to stop early. We keep going.”

The specialized clinic operates one day a week at Stanford Hospital and twice a month at a clinic in Monterey, and has about 150 patients.

A mortal enemy

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 combined, according to the American Heart Association (AHA).

Yet heart disease in women is consistently misdiagnosed and undertreated, and more women than men have died of cardiovascular disease every year since 1984.

Play eases the anxiety of Bernard Dannenberg's young patient.

Jennifer Tremmel, MD (right), and Mary Nejedly, a nurse practitioner, look over test results at Stanford's Women's Heart Health Clinic.

“The sex gap in cardiovascular disease hit its peak in 1999 and is finally getting some attention,” said Tremmel, who is conducting an AHA-funded study on sex differences in cardiovascular disease. 

The growth in women’s heart centers is targeting this apparent inequity of care, said Sharonne Hayes, MD, director of the Women’s Heart Clinic at the Mayo Clinic in Minnesota and a member of the advisory board of WomenHeart: the National Coalition for Women with Heart Disease.

“There are still marked disparities in care,” Hayes said. “Women are less likely to be prescribed medication or be as intensely treated as men. Women also don’t feel like they are being listened to when they discuss their symptoms with their doctors. Nobody ever sat down and adequately addressed their concerns.”

Applying new data

This is where a clinic specifically targeting women can help, Tremmel said. As an expert on women’s heart health, she keeps up to date on research, and after treating so many women in a large group, she’s more attuned to their different needs.

“It’s amazing how similar all these women are when you get them together in one clinic,” Tremmel said.

For example, while women and men suffer many of the same symptoms of heart disease, such as chest pain or shortness of breath, women may also experience back, neck or arm pain, and they often report symptoms when under emotional stress.

“We’re finding it just doesn’t work to treat women like men using data derived from men,” Tremmel said. “There’s enough data out there that we can start treating women like women, and hopefully it will lead to an improvement in outcomes and a reduction in the gender gap.”

There has been a push over the past decade to conduct more research on women’s cardiovascular disease, such as the National Institutes of Health–sponsored study called the Women’s Ischemia Syndrome Evaluation (WISE), which found that just because a woman’s arteries appear clear on routine tests like an angiogram, it doesn’t mean she has normal coronary arteries.

“The WISE study has been pivotal in shaping my research career,” Tremmel said. “Up to 20 percent of patients with symptoms are found to have normal-appearing arteries in the cath lab. We tell them that they are fine, but they continue to have symptoms and we have no good explanation. It’s extremely frustrating for doctors and patients.” 

To make an appointment at the Women’s Heart Health Clinic, please call (650) 723-6459.

« Back to Contents

Footer Links: