Women may have “come a long way, baby” in voting and politics, but not so when it comes to treating heart disease.
There is still a huge gender gap for women with respect to diagnosing and treating heart disease. Study after study, even within the past three years, has shown that women are not diagnosed as quickly as men, nor are they treated with recommended medications and procedures as often as men. And perhaps that’s why when women are finally diagnosed and treated, they don’t fare as well.
Cardiovascular disease kills more women than men every year — and almost 10 times more women than breast cancer, according to the American Heart Association. So where is the advocacy, the indignation, the walks for a cure?
“Breast cancer, with its outward visible scars, is still more jarring for women than heart disease — which is 10 times more deadly,” according to Dr. Mandeep Mehra, professor and division head of cardiology at the University of Maryland School of Medicine,
Some of the blame lies with women who notoriously put themselves last, especially when it comes to their health.
Women are vigilant when it comes to heart health for their spouses, Mehra said. However, he finds the reverse is not true.
“I have yet to find a man who accompanies his wife to an appointment with documented Internet research and a list of questions.”
Dr. Erin Michos, a cardiologist at Johns Hopkins School of Medicine who co-authored the American Heart Association’s Cardiovascular Prevention Guidelines for Women, agrees. “Women are the gatekeepers of health for the whole family; when they take care of themselves the whole family benefits.”
It isn’t that women blatantly ignore their symptoms; many women don’t even realize they are having symptoms of a heart attack. Unlike men who have easily identifiable crushing chest pain and shortness of breath, many women have vague complaints that could easily be attributed to other problems. Mehra describes “indigestion and fatigue, even something as ambiguous as a change in sleep pattern.”
It’s these nondescript complaints that account for a recent study published in January’s online issue of Circulation: Cardiovascular Quality and Outcome. Researchers found women with these types of cardiac symptoms, when compared to men, were 50 percent more likely to be delayed by 15 minutes in getting to the hospital via ambulance.
Another study published in December 2008 in the journal Circulation, found that women who had a more severe type of heart attack called STEMI (ST Elevation Myocardial Infarction) were twice as likely to die as their male counterparts. Women also were less likely to receive the standard treatments, a factor that may have contributed to the higher mortality rate. The study found women were 14 percent less likely to receive aspirin therapy to prevent platelet and blood clots, and 10 percent less likely to receive beta-blocker medications to lower heart rate and blood pressure. They also were 25 percent less likely to receive reperfusion therapy such as angioplasty and stents to restore blood flow after arriving at the hospital.
Both of these studies, Michos said, “are very frustrating. Gaps lie not only with treatment in the hospitals but getting to the hospital, too.”
The key to closing this gap is education on all levels because the bias is happening at all levels. An American Heart Association survey found only 21 percent of women realized heart disease as their greatest health risk. Another survey among doctors found that fewer than 1 in 5 knew that more women died of heart disease each year than men.
Women need to know their symptoms but more importantly they need to know their risk factors: smoking, a strong family history of heart disease or diabetes, and numbers for blood pressure and cholesterol. One or more risk factor can totally negate any beneficial protection estrogen gives to younger women with respect to heart disease, according to Michos. And historically it’s that idea of the estrogen benefit that might have initially created the bias we see today.
“Prevention is the best intervention,” said Michos, who encourages women to empower themselves and take action. The more they pay attention to their own heart health, the more they will get their doctors to do the same.
Mehra’s biggest piece of advice: “Don’t take no for an answer. If you feel you’re still having a problem, don’t stop until you find a doctor who finds the problem.”
The ABCs of Heart Disease Prevention
A — Aspirin and Anti-platelet therapy
B — Beta Blockers and Blood pressure control
C — Cholesterol and Cigarette cessation
D — Diabetes prevention, and Diet and weight management (Measure waist circumference.)
E — Exercise
F — Framingham Risk Assessment, which estimates 10-year risk for having a heart attack
G — Goals for behavior change
Leigh Vinocur is a board-certified emergency medicine physician at the University of Maryland School of Medicine.
