What are the health policy implications of male-female differences-and
similarities-in heart disease? What types of therapies are best suited for
each sex? Which will have the greatest benefit per dollar spent?
It is questions such as these that Milton Weinstein, the Harvard
Professor of Health Policy and Management and Biostatistics, has sought to
answer. Weinstein has analyzed the cost-effectiveness of a wide range of
health interventions-from cholesterol reduction to blood pressure control to
estrogen replacement. His findings are helping set the policy agenda for
reducing heart disease across the country.
"For post-menopausal women, studies have suggested that estrogen supplements
can produce a 20 to 40 percent decrease in coronary heart disease rates,"
says Weinstein. "Our analysis indicates that if these reductions are
accurate, they would swamp the much smaller increase in breast cancer risk
associated with estrogen treatments."
Weinstein and his colleagues have developed a computer program, called the
Coronary Heart Disease Policy Model, that enables them to simulate the
impact on heart disease rates of a wide variety of health interventions. "In
one study, we asked,ŒWhat type of cholesterol-lowering program would be most
cost-effective? Is it better to target people with high cholesterol or try
to lower the cholesterol levels of an entire population?'" The investigators
found that whereas women would benefit more-dollar-for- dollar-from a
targeted approach, men would benefit more from a broad, "population"
approach.
The reason? Although women's-particularly young women's-overall heart
disease rates may be lower than men's, elevated blood-cholesterol levels are
a greater risk factor in women than in men. (The reasons for this disparity
are not well understood.) "We concluded that different strategies are needed
in cholesterol-reduction programs for men and women," Weinstein remarks.
What about reducing high blood pressure, quitting smoking, and losing
weight? Do the benefits accrue equally to both sexes? In one study,
Weinstein found some modest disparities. A 35-year-old male smoker who gives
up cigarettes adds, on average, 2.3 years to his life expectancy. An
overweight man who trims down to normal levels gains 1.7 years; and a man
who lowers his high blood pressure to a normal range nets an additional 2.3
years. For women, the increases are 2.8 years, 0.5 years, and 1.7 years,
respectively. Although these numbers seem relatively modest, they represent
population-wide averages, and the benefits to particular individuals can be
far greater, Weinstein notes.
As these statistics indicate, the similarities in heart disease rates in men
and women ultimately outweigh the differences. Old stereotypes die hard, but
heart disease is increasingly recognized-by the medical community and the
general public-as a concern for both sexes.
At heart, men and women are more alike than they sometimes seem.