Why women suffer worse outcomes than men when it comes to heart disease
This February is REDFEB, heart awareness month. In addition to encouraging people to wear red and donate, Heart Research Australia is raising awareness about the underdiagnosis and undertreatment of women with heart disease.
“We’ve found over recent years that women are doing worse after their heart attacks, they’re more likely to have another heart attack, and more likely to die or have heart failure than men within the five years following their heart attack,” says cardiologist Dr Monique Watts, a heart failure cardiologist and specialist in women’s heart disease who works at the Epworth and the Alfred Hospitals in Melbourne.
University of Sydney research recently revealed that women admitted to Australian hospitals with serious heart attacks are half as likely as men to get proper treatment and to die at twice the rate of men six months after discharge.
“Time is critical when it comes to heart disease and a huge issue with women is the delay to treatment. Women go to the hospital later after symptoms start, which reduces the window of opportunity for effective treatment and increases the risk of complications and damage to their heart,” says Nicci Dent, CEO of Heart Research Australia.
“There are many things that contribute to this. One big problem is the myth that women aren’t at risk. Traditionally heart disease has been viewed as a bloke’s disease, but globally heart disease is the number one killer of women,” continues Ms Dent.
Dr Watts says another issue is the focus on male-specific symptoms and risk factors.
“Most medical research is conducted in studies of men, and therefore clinical guidelines, symptom checklists and treatments are tailored to men. It means women are diagnosed with heart disease seven to 10 years later than men, and are less likely to be referred for heart tests or heart surgery. We know that smoking, high cholesterol, being overweight and a sedentary lifestyle are all risk factors discovered from research on men. What isn’t well publicised are the very clear and specific risk factors for women,” explains Dr Watts.
“Early menopause, inflammatory conditions such as rheumatoid arthritis and lupus, and complications during pregnancy – such as pre-eclampsia, hypertension, and gestational diabetes – are all important risk factors for women. Even smoking confers a much higher risk of heart disease for women than it does in men,” says Dr Watts.
Professor Gemma Figtree recently found, through her research supported by Heart Research Australia, that women with no ‘Standard Modifiable cardiovascular Risk Factors’ have the highest chance of dying from their heart attack, with 18% dying at 30 days. This mortality rate is 3 times that of men with at least one risk factor (6%).
“Research is only now beginning to uncover the biological, medical, and social reasons for these differences. Hopefully this will lead to advances in tailoring prevention and treatment to women,” says Professor Figtree.
Women also tend to develop symptoms of heart disease at a much later stage of the illness than men and their symptoms are often vaguer or ‘non-specific’, which can also cause a delay in diagnosis and receiving time critical care.
“Many women don’t experience the crushing chest pain that is a classic symptom of a heart attack in men. Some feel extremely tired or short of breath. Other atypical symptoms include nausea and abdominal, neck, and shoulder pain,” says Ms Dent.
Physiological differences between the hearts of men and women may contribute to these differences.
“In men, a heart attack is frequently caused by a blocked artery which is easily diagnosed during an angiogram and has a clear evidence-based treatment pathway. In women, the heart attack may be caused by a transient blockage resulting in multiple smaller heart attacks, or an artery that spasms down intermittently. When there is no clear blockage evident to explain the heart attack syndrome, the initial heart attack diagnosis can sometimes be retracted, leaving women vulnerable and at substantial risk,” says Dr Watts.
New research in the US has reinforced the problem of diagnosis and treatment when women present with heart issues despite the fact that guidelines are the same for men and women.
“Our study found that women are advised to lose weight, exercise and improve their diet to avoid cardiovascular disease but men are prescribed lipid lowering medication,” says Dr. Prima Wulandari of Harvard Medical School and Massachusetts General Hospital, Boston, US.
In fact, men were 20% more likely to be prescribed statins than women. On the other hand, women were 27% more likely to be advised to lose weight, 38% more likely to be told to exercise, 27% more likely to be instructed to reduce their salt intake and 11% more likely to be told to reduce their fat or calorie consumption.
In other research 1 in 4 (26%) women agreed that heart disease was embarrassing and 45% of women cancelled or postponed a physician appointment until losing a few kilos[iii]. Almost one-half of the women reported the barrier that it was common to delay seeing their physician until they had lost weight, to present their best self.
“I have certainly looked after women who have delayed treatment because of misplaced shame or guilt. We need raise awareness about the many non-modifiable factors for heart disease, including genetics, to help destigmatise the condition and improve outcomes for women,” says Dr Watts.
This REDFEB, Heart Research Australia implores women to be more active in seeking help when experiencing heart problems rather than neglecting the problem.
For earlier identification of cardiovascular disease and more timely and appropriate medical intervention it is advised for women over 45* to have a heart health check and to discuss their obstetric history if they have had children with their current GP. This enables proactive prevention to be taken to reduce risk. (*Over 35 for Aboriginal and Torres Strait Islander peoples.)
Heart disease: Expert tips for women
• Find a good GP that is willing to listen to your concerns and include cardiovascular health as part of a preventative health plan, just like skins checks or pap smears. Cholesterol and blood pressure should be assessed and managed.
• Share your obstetric history with your GP, especially if you have had pre-eclampsia, hypertension, gestational diabetes or premature delivery.
• Understand that Inflammatory conditions such as lupus or rheumatoid arthritis can put you at higher risk.
• Peri menopause / menopause is a time where estrogen levels fall. This fall in estrogen brings about changes in the body that increase risk of heart disease. Menopause is a good time to talk to your GP about what your risk of heart disease is and how it can be minimised.
• Focus on overall general health such as exercise, eating health, stopping smoking and weight management, but also understand that non-modifiable factors and genetics also come into play.
Don’t put off speaking to a GP about your risk because you are worried about being judged.
This February, Heart Research Australia invites all Australians to wear RED for someone close to their heart to help keep families together for longer.
“The simple fact is that research saves lives, which is why Heart Research Australia funds world-class and emerging researchers to conduct ground-breaking research into the prevention, diagnosis and treatment of heart disease,” finished Ms Dent.
For more information on REDFEB and to donate, please visit: www.heartresearch.com.au