Harvard Women's Health Watch

A device to prevent heart failure is twice as effective in women

Women tend to develop heart disease about 10 years later than men — in part, it's believed, because of the heart-protective effects of ovarian estrogens, which are around until menopause. But the female advantage seems to end there. Because women develop heart disease later, they're more likely to have coexisting conditions, like diabetes, which can complicate treatment and recovery. And because they have smaller hearts and coronary vessels, surgery can be more difficult for them. Women are more likely to die after procedures such as bypass surgery and angioplasty.

But now a study suggests that one treatment for heart failure actually works better in women than men (Journal of the American College of Cardiology, Feb. 15, 2011).

The treatment, called cardiac resynchronization therapy with defibrillator (CRT-D), is an implantable device that helps the heart maintain its rhythm. In heart failure, the two lower chambers of the heart — the right and left ventricles — don't contract and relax as they should. This reduces the heart's ability to pump oxygen-rich blood to the rest of the body, causing shortness of breath, fatigue, and sometimes an accumulation of fluid in the lungs and legs. CRT-D stimulates the ventricles to work together more effectively, and if the heart's rhythms should go awry, the defibrillator part of the device administers a shock to set them right. CRT-D eases symptoms, lengthens life, and reduces the risk of hospitalization in people with severe heart failure. It can also help prevent less severe heart failure from getting worse.

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