5 myths and realities about women’s heart health

 
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February 3, 2020

In January, Journalist’s Resource attended a four-day fellowship on cardiovascular health, “Covering the Heart Beat,” organized by the National Press Foundation. Researchers, physicians and journalists gathered with the goal of improving news coverage of cardiovascular health.

At the training, Dr. Noel Bairey Merz and Dr. Martha Gulati delivered presentations on women’s heart health. Bairey Merz is director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles, and chairs the National Institutes of Health-sponsored Women’s Ischemic Syndrome Evaluation (WISE) initiative, a project aimed at better understanding heart disease in women. Gulati is chief of cardiology at the University of Arizona College of Medicine-Phoenix and co-author of the book Saving Women’s Hearts.

They broke down oft-repeated myths about cardiovascular disease in women and shared the facts of the matter. This tip sheet summarizes a few of their key points.

Myth: Cardiovascular disease is a man’s disease.

Reality: Women and men have similar rates of cardiovascular disease.

Nearly half of all women in the U.S. — 60 million — have cardiovascular disease, which includes coronary heart disease, heart failure, stroke and hypertension, according to the most recent statistics from the American Heart Association. A similar number of men — 61.5 million — have cardiovascular disease. For comparison, about 3.5 million U.S. women have breast cancer.

Myth: Women don’t die from cardiovascular disease nearly as often as men do.

Reality: Cardiovascular disease is the leading cause of death for both sexes. In 2017, 418,655 women and 440,460 men died of cardiovascular disease.

Myth: Heart disease looks the same in men and women.

Reality: Bairey Merz said research has found that heart disease in women often looks different, quite literally, than it does in men. For example, plaque on the walls of women’s arteries looks different from the plaque on men’s. It also affects their arteries differently.

Diagnosing a heart attack in women requires more sensitive blood testing, Bairey Merz added, because their hearts are generally smaller and release smaller amounts of troponin, a protein the body releases when the heart muscle has been damaged.

These differences might explain why heart disease in women isn’t always diagnosed and treated promptly. But researchers haven’t always considered men and women separately enough, Bairey Merz said.

She described a consequential 1991 letter to the editor in the New England Journal of Medicine written by Dr. Bernadine Healy, then director of the National Institutes of Health. “Yentl, the 19th-century heroine of Isaac Bashevis Singer’s short story, had to disguise herself as a man to attend school and study the Talmud. Being ‘just like a man’ has historically been a price women have had to pay for equality. Being different from men has meant being second-class and less than equal for most of recorded time and throughout most of the world,” Healy writes.

Healy applies the story of Yentl to heart disease. She argues that only recognizing heart disease in women when it presents similarly to men’s heart disease, and treating women’s heart disease as the same as men’s, leads to inferior diagnosis and treatment of heart disease in women.

“The problem is to convince both the lay and the medical sectors that coronary heart disease is also a woman’s disease, not a man’s disease in disguise,” she writes. “Decades of sex-exclusive research have reinforced the myth that coronary artery disease is a uniquely male affliction and have generated data sets in which men are the normative standard. The extrapolation of these male-generated findings to women has led in some cases to biased standards of care and has prevented the full consideration of several important aspects of coronary disease in women.”

Bairey Merz added that the “Yentl syndrome” still afflicts the field today: “The health care establishment still, I think, has these gendered ideas of not doing research in women.”

Myth: Men and women both receive the standard of care for cardiovascular disease.

Reality: Men often are more likely to receive care that follows established guidelines for treating cardiovascular disease than women.

“When a woman has a heart attack, do we even treat women equally?” Gulati asked. The short answer, she said, is: no.

The long answer: A 2012 paper in the American Journal of Medicine found that women were less likely to receive care concordant with established guidelines for heart attack — and were more likely to die from the condition — than men. The study looked at a sample of 31,544 patients from 369 hospitals across the U.S. between 2002 and 2008.

A few of the differences highlighted in the study:

  • Women were less likely to get aspirin or a beta blocker within 24 hours of a heart attack, which is the standard of care.
  • They were less likely to undergo any type of invasive procedure to treat the heart attack.
  • They also were less likely to receive anti-blood clotting therapy within 30 minutes of going to the hospital, another standard of care.
  • In addition, women were less likely to receive timely coronary angioplasty – the insertion of a tiny balloon into the artery to clear a blockage, which is recommended within 90 minutes of being admitted to the hospital.
  • Younger women experiencing heart attacks suffered worse outcomes than older women — higher mortality rates and lower-quality care.

“The only thing women do better is die,” Gulati said. “Even when we don’t have all the answers about the [sex-related cardiovascular disease] differences… if we just followed the guidelines, we would save lives.”

Differences in care aren’t limited just to the clinical setting. Gulati said that in out-of-hospital cases of cardiac arrest, women are less likely to receive bystander-initiated cardiopulmonary resuscitation (CPR) than men. “We know the sooner we initiate CPR, the more likely we are to save lives,” she said. As it stands, women are less likely to survive cardiac arrest than men.

Gulati suggested the reasons why CPR is not performed as often on women might have to do with concerns about touching women, or the fact that people are trained to perform CPR on male mannequins rather than female figures. That might lead individuals to believe they do not know how to perform CPR appropriately on a woman, Gulati said.

Myth: Women experiencing heart attacks report so-called “atypical” symptoms such as stomach pain, pain in the jaw and heart palpitations, rather than “typical” symptoms like chest pain, pressure or tightness.

Reality: Research shows that women are actually more likely than men to report typical symptoms, but are also more likely to list a greater number of symptoms.

“The public health message has really somehow gone out there as if every woman will present atypically rather than most people will present with the typical symptoms,” Gulati said.

A 2018 study in Circulation finds that a similar percentage of men and women reported chest pain when seeking help for a heart attack — 89.5% and 87%, respectively. Women, however, were also more likely to report three or more additional symptoms than men. Additionally, both women and their healthcare providers were less likely to consider women’s symptoms heart-related than men and their providers. For example, women were more likely to consider their symptoms related to stress or anxiety, and 53% of women reported that their provider did not think their symptoms were heart-related, compared with 37% of men.

 

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