Heart disease in women is under-diagnosed, under-treated and under-researched: Heart and Stroke report
Patti LeBlanc had just finished preparing her vegetable dish for her church’s December potluck when she felt an odd sensation throughout her body while putting her stuff in her car.
At first, the marathon runner dismissed it as nothing and continued about getting ready for the potluck. But as she drove to the church, a feeling of pain in her chin and face manifested. Her chest also felt very heavy and LeBlanc couldn’t quite catch her breath, but she kept on driving.
Moments later after arriving at her church, the then 49-year-old’s arm began to tingle and it quickly became numb.
“That was when I first thought that I could be having a heart attack,” said LeBlanc, who’s from Winnipeg and was 49 at the time. “So I got in my car and phoned my husband right away and told him something was really wrong, and that I might be having a heart attack and told him to call an ambulance.”
LeBlanc rushed home to meet paramedics, who gave her two Aspirins and drove her to the hospital, where she was wheeled into surgery.
For three hours, doctors worked on two tears in her arteries, which is also known as a SCAD, or a spontaneous coronary artery dissection.
“It was a shock that I’d had a heart attack,” she says. “I’d done everything to not have a heart attack – I ate well, exercised and managed my stress. I remember being quite bitter about the predicament I was in.”
It may have taken a buildup of symptoms for LeBlanc to realize she was having a heart attack, but many women and physicians fail to actually recognize the early symptoms of a heart attack in women at all. In fact, early heart attack signs were missed in 78 per cent of women, according to a new report by the Heart and Stroke Foundation.
“[Heart disease] is a major cause of death and I think people really still don’t understand that,” Dr. Karin Humphries, scientific director of the B.C. Centre for Improved Cardiovascular Health, says. “I think if you ask the average woman on the street what her biggest health concern is, it’s probably dying of breast cancer – which is not to minimize that that isn’t important. But women are actually five times more likely to die of cardiovascular disease. It’s a major killer of women.”
According to the report, when it comes to women and heart disease, they are under-researched, under-diagnosed and under-treated – not to mention under-supported and under-aware – and it’s chalking up to be a very dangerous combination for the future of women’s heart health.
Where’s the research?
The system’s failure in women’s heart health started with research where for years, therapies were tested in studies that primarily involved middle-aged, white men.
In reality, two-thirds of heart disease clinical research focuses only on men, despite women comprising 51 per cent of the population, the report notes.
Researchers believed that what they learned from these study groups could be applied to all, thus forming the basis of clinical guidelines, diagnostics and therapies that are still widely used for both sexes today.
“I think there was a real reluctance to enrol women because of concerns of adverse effects if they happen to be pregnant – you know, the complexity of women’s hormone change – I think that’s where it started,” Humphries says. “But when you start making assumptions of what works in men will work in women, you can really get into trouble. We have now learned that medications and treatments that are shown to work in men, some of those can actually have adverse effects in women.”
That’s because women’s hearts and the way they experience heart attacks are different than men, Humphries explains.
WATCH: A new report suggests a bias in the Canadian health care system when it comes to women’s heart health. The Heart and Stroke Foundation calls it a “glass ceiling.” Su-Ling Goh explains.
The difference between men and women’s hearts
When a heart attack is imminent, both men and women usually report pain as their primary sign – but how both sexes describe that pain is often different.
For example, women will usually describe it as pressure or tightness, and they’re more likely to describe other signs like nausea, unusual fatigue or jaw pain.
Because of this difference in how women communicate and the type of symptoms women often experience, physicians are more likely to look for other causes associated with the symptoms in women without doing the appropriate testing to rule out cardiac issues, the report says.
But there are physical differences as well.
Men, Humphries says, are more likely to present with blockages in the major large coronary vessels while women tend to have dysfunctions in the smaller coronary vessels.
This causes a problem with it comes to testing because coronary angiograms, which is an X-ray of the inside of the coronary artery, will only pick up on the blockages in the larger arteries.
Under-diagnosed and under-treated
According to the report, women in Canada are less likely to receive care from a cardiologist, or to be referred for “aggressive diagnostic tests or treatments.”
For example, only 29 per cent of women receive an ECG within the 10-minute benchmark, compared to 38 per cent of men. And in cases where a patient needs a close-dissolving therapy, only 32 per cent of women will get it within the 30-minute benchmark, compared to 59 per cent of men.
This, Humphries says, is due to the fact that diagnostic tools were optimized for the version of the coronary disease that men have. Like with the exercise treadmill (or stress test). The output is far less sensitive for women compared to men, and even worse for younger women compared to older women.
And a misleading diagnosis delays early treatment. The most important thing when it comes to a heart attack is time so blood flow can be restored as quickly as possible.
Lastly, women are also less likely to be put on needed medications, like blood pressure or cholesterol-lowering medicines after a heart attack, the report states. The reason why is not yet known.
What women need to know
Many are not aware of just how much of a threat cardiovascular disease is to women.
Not only do women not know that heart disease claims the life of one in five women, but they are also unaware that some risk factors (like high blood pressure, diabetes, alcohol intake and lack of exercise) pose an even greater risk for them than for men.
To find out why that is, the Heart and Stroke Foundation conducted a survey of 2,000 Canadian women between the ages of 19 and 29, and found that only 37 per cent of women believe heart disease can be different for women than men.
On top of that, 40 per cent continue to eat unhealthy foods five times or more throughout the week. As well, 58 per cent report experiencing stress most or every day.
“We used to say your risk [of heart disease] increases after menopause but that is way too late for women to be aware of their heart health,” Humphries says. “I think women need to be aware of that already in their 30s. By that I mean they need to consult with their doctors to review their risk – is there a family history or coronary disease? That’s a major predictor that they might be at risk.”
Women also need to make sure they have a healthy diet, as well as fit in regular exercise and monitor their blood pressure and cholesterol, Humphries adds.
“These are all things that need to be looked at earlier in life and not waiting until we’re in our late 50s or so,” she says.
It’s been two years since LeBlanc had her heart attack, but that doesn’t mean she’s in the clear yet.
After recovering, LeBlanc entered cardiac rehab where they helped her get back on her feet.
It took about a month for the school teacher to start running again under the direction of her team, but with limitations. These limitations include not allowing her heartbeat go over 130 beats per minute, so now when LeBlanc runs, she has a heart rate monitor with her at all times.
But it has not stopped her from doing what she loves. In fact, since her SCAD, LeBlanc has been able to run several marathons – two of which were in the same weekend.Follow @danidmedia
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