The Five Unders of Women and Heart Disease
Answer me this. If you feel as if there’s an elephant sitting on your chest, you should
a) call the zoo and ask if Dumbo has gone missing.
b) wake yourself up because you are dreaming.
c) get to the hospital. You may be having a heart attack.
C’mon. You don’t really think that Profound Journey’s first-ever pop quiz would be that easy, do you? There’s nothing simple, and nothing funny, about women and heart disease, as the Heart and Stroke Foundation of Canada recently made clear in their excellent report, Ms. Understood.
If anything in the universe reflects the fingerprint of God, it is the human heart…It derives no benefit from the blood it pumps making it the most unselfish of organs….it is also the most courageous and faithful.Charles Martin
In reading the twenty page report, this is the sentence that echoes in my brain:
Today, when it comes to heart disease, women are under-researched, under-diagnosed and under-treated, under-supported and under-aware.
Two-thirds of all clinical research has been undertaken with middle-aged white men as the research subjects. When it comes to the reasons for this finding, which of the following statements is NOT true? You can choose more than one if you wish.
a) Any heart is every heart. Men’s and women’s hearts are the same.
b) Women are too busy taking care of others to participate in research trials.
c) Hormonal changes in women complicate research studies.
d) Most researchers are male.
e) Women have been deliberately excluded from research studies out of concern for their safety.
About that last one, here’s something I didn’t know. Until maybe twenty years ago, if you were anywhere in the range of having started menstruating to not having begun menopause, you were excluded from research studies on the assumption that you were ‘potentially pregnant.’ This was a direct response to the thalidomide drug trials of the 1960s that resulted in tens of thousands of infants born with severe impairments.
Research protocols are much improved, but women are still under-researched for most of the reasons in our quiz question. This is a huge problem because research studies are what provide physicians with the clinical guidelines, diagnostic procedures, and treatment options they follow. And, since men’s and women’s hearts are NOT the same, the impact of this systemic bias is far-reaching.
True or false?
a) Heart disease tends to be located in the major coronary arteries for both men and women.
b) An angiogram is the standard diagnostic tool for all forms of heart disease.
c) A stress test, performed on an exercise treadmill, is equally effective for men and women.
All three statements are false. While women’s hearts look the same as men’s, there are significant and important differences including:
- Women’s hearts and coronary arteries are smaller than men’s.
- There are differences in the way plaque builds up in women’s blood vessels.
- Hormonal changes, pregnancy, and menopause impact women’s hearts.
- There are differences in the electrical patterns in women’s hearts.
- Women have lower blood pressure and a faster resting heart rate than men of the same age.
An angiogram is indeed the standard diagnostic tool for heart disease, however, its use is in examining the major coronary arteries, the site of most men’s heart disease. Women tend to have disease in the small vessels of the heart.
And stress tests, it appears, are far less sensitive for women compared to men. Even within the female population, stress tests are less helpful for younger women compared to older women.
What is most important immediately following a heart attack?
a) keeping the patient calm to avoid further damage
b) exploring to determine the cause of the heart attack
c) restoring blood flow as fast as possible
The critical element is time, yet only 32% of women receive clot-dissolving therapy within thirty minutes, as compared to 59% of men.
Blood pressure medication and cholesterol-lowering medication are often necessary after a heart attack, however, women are much less likely than men to be on these medications. I’d love to turn the reasons into a quiz question, but we don’t actually know what’s going on here. It could be that physicians aren’t prescribing; that women aren’t filling the prescriptions, or that the drugs are sitting untouched in home medicine cabinets.
What we do know is bluntly summarized in the Ms. Understood report:
- Heart disease is the leading cause of premature death for women in Canada (dying before reaching their expected lifespan).
- Every 20 minutes a woman in Canada dies from heart disease.
- Five times as many women die from heart disease as breast cancer.
- Women who have a heart attack are more likely to die or suffer a second heart attack compared to men.
Long-term (12-24 week) cardiac rehabilitation programs result in a 25% reduction in mortality, less depression, and better quality of life. Cardiac rehabilitation programs are not invasive. They include exercise, education, psychosocial support and healthy lifestyle counselling.
Nevertheless, women are only half as likely to attend and to follow a cardiac rehabilitation program as men. Why? Choose all that apply.
a) Doctors don’t refer women as often as men.
b) Women are too busy taking care of other people to attend these programs.
c) Cost can be a barrier if the program fees aren’t covered because women live in poverty more so than men.
It won’t surprise you to learn that all of these statements are true.
It’s easy to gloss over a list of heart attack signs in a multiple-choice question. You really know your stuff, however, if you can complete these sentence starters:
- Women might be having a heart attack if they feel… (try to come up with 5 responses).
- Early signs of a woman’s impending heart attack, experienced repeatedly over weeks and even months, may include … (try for four responses).
The early warning signs of an impending heart attack are missed in an alarming 78% of women. However, that’s not especially surprising given that the early warning signs are subtle and easily attributable to other causes. They include weakness, fatigue, dizziness, and shortness of breath.
The signs of heart attack are summarized in this infographic.
(c) 2018 Heart and Stroke Foundation of Canada
Reproduced with permission of Heart and Stroke Foundation of Canada
Additionally, many of us are not aware that:
- certain risk factors–specifically, high blood pressure, diabetes, alcohol consumption, and lack of physical activity–pose a greater threat to women than to men.
- problems during pregnancy (gestational diabetes, hypertension, and pre-eclampsia) doubles a woman’s lifetime risk for heart disease.
- young women (19-29), visible minority women, and female residents of Quebec lead the pack in having difficulty answering survey questions about women and heart disease.
What We Can Do to Combat Heart Disease
The Ms. Understood report concludes with the statement that “Women and men should strengthen their heart health literacy, becoming familiar with their risks, similarities and differences.”
Protect your heart, love yourself, and be with people who love and care for you.Sue Fitzmaurice
There’s no question that’s good advice, but there’s another statement in Ms. Understood that I find particularly poignant and haunting. It was made by Heart and Stroke CEO Yves Savoie who said,
What women told us is that the act of caring is their strength. What we, as families, as spouses, as a society, need to do is to help women understand that taking control of their own health is actually part of caring, too.
On this site, I have talked about many forms of self-care from eating chocolate to enjoying a hot bath, from taking naps to buying yourself flowers. All can be helpful, but only if you are around to enjoy them.
So, Profound Journey tribe members, in this month of hearts and love, let’s show a little self-love by taking control of our own health. Read the full Ms. Understood report. It includes women’s personal stories. Share those stories and this information with other women. Donate money, if you can, to support research into women’s heart health. Lend your time and your voice to advocate and to educate.
I’m a legacy donor with the Heart and Stroke Foundation of Canada. That means they get small donations now during their campaigns, but will get a big one when I die…in thirty plus years, in my sleep, of natural causes. My reasons for donating are many, but they can all be summarized by the tagline that accompanies the Foundation’s new logo. It’s a brilliant tagline. You will find it on the last page of Ms. Understood.