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. woman's hands cupping a red heart 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.woman's feet on treadmill 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.infographic signs of heart attack

(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. 


  1. This made me think of current coverage here about the story that prostate cancer is now a bigger killer than breast cancer. Apparently that’s all our fault for being feminists or something. One more rational reason suggested is that women are more open to going to the doctor and talking about potentially embarrassing problems. So maybe we are quite good at self-care (sometimes).

    1. Good point, Anabel. Plus the campaigns around breast cancer have been huge and long-term so we know to take care of ourselves in that regard. Hopefully some women-focused campaigns about heart disease will lead to similar results.

  2. I was stunned the first time I read how women were so different compared to men when it came to heart disease and the risks of heart attack. Who would have guessed there would be so many differences between the sexes?

    Thanks for the summary and the reminder. This is sobering.

  3. What an insightful post, Karen. It’s true that thalidomide swung the pendulum way too far the other way and is the basis for excluding women from so many studies even today. Education about signs and symptoms and ways to prevent heart disease in women is very important and you’ve covered them well today in your post. Self care is vital to a long and happy life!

    1. Thanks very much, Molly. I was surprised by the findings in the Heart and Stroke Foundation’s report. I didn’t know that women had been excluded from research studies. It’s clearly time for me to own my own health!!

  4. Women’s heart attacks and dealing with the medical community regarding same has touched my life in a couple of ways.

    Almost four years ago my friend (and matron of honour at our wedding) had a heart attack at work. Luckily she works in Human Resources at our local hospital. One of her colleagues noticed she looked unwell and asked her if she felt ok. She mentioned that she was really tired and a bit nauseous and when the colleague suggested she go down to Emerg to get checked out she started walking in that direction! Then it was no, no, no and grab a wheelchair and run with the wheelchair down the hall to the Emergency Department. She was taken right in but I wonder if that had more to do with the fact she was an employee of the hospital than with her description of her symptoms. I was not there so I can not say how she was treated or what questions she was asked nor what tests were run on her. Since our hospital does not have any heart specialists everyone from our area are sent to Sudbury, a city about two hours north of us. She was rushed there via helicopter flight transfer between hospitals and through angioplasty received life-saving help opening up of a couple of arteries and a couple of stents to keep them open. My friend was 44 years old when this happened. I talked to her just a couple of nights ago and she still has angina pain but deals with that as she needs to.

    The second time was personal. About two and a half years ago I was rushed to the Emerg with chest pain (pressure and tightness), sweating and shortness of breath. I was ushered right through and promptly hooked up to an EKG and oxygen via nasal cannula. From the questioning of the physician, as soon as he learned I also have asthma, the focus immediately went to a diagnosis of asthma attack rather than anything heart-related. Upon learning that my father had a heart attack when he was 52 and heart disease was an issue in my family I was monitored for over an hour and blood test was taken to check for markers that show up in the blood after a heart “event”. Luckily for me, that test was negative. I was sent for a stress test on the treadmill about two weeks later – which I also passed.

    As a result of both of these stories I have related I am convinced, there is a very real difference in how women are treated in regards to heart health compared to men. I read (and downloaded) that 20-page report, Karen, you are right the tagline is brilliant. Thanks for this post and for doing your part to share information with women everywhere.

    1. Personal experiences, like the ones you recount and the ones described in the Heart and Stroke Foundation report, do so much to bring real awareness to these issues. We learn through stories, Susan. Thanks for sharing yours.

      1. You’re welcome, Karen, I forgot to mention that I love that heart shaped EKG graphic…saved it to my Pinterest board in my Profound Journey folder.

  5. I like the name of this report, Karen, Ms. Understood. How clever. As with all (health) issues in our lives, it all starts with being aware and informed. Education, once again, saves lives.

    A little while ago, I heard a National Public Radio broadcast point out the high risks of heart disease in women, so your article doesn’t come as a total surprise. Apparently, the symptoms can be wide and “benign”, comparable to other diseases as you point out. Tricky!

    As women, I think we go to the doctor less often, take medicines less frequent and complain less about physical pain than men. I think this could be a cause of more heart disease fatalities among women..

    1. I love the report name too, Liesbet. It fact it’s so clever that it caused a big problem when I was trying to come up with a post title. Nothing, absolutely nothing, could beat or even match Ms. Understood.
      Anna, in her comment below, certainly supports your observation about the differences in the way women talk about their symptoms.

  6. I volunteer 5 hours a week at my local hospital emergency room. Many, many times I have seen men come in with a pain in their chest, sometimes in their jaw and sometimes down their arm. They are totally convinced they are having a heart attack and need treatment immediately. I have also seen women come in, sweaty, in pain, with trouble breathing and pain in their jaw who try to convince me they are NOT having a heart attack. Your post was spot-on Karen, women and men have indeed been conditioned differently – and that has to change. Admittedly, it is women who have to lead the charge on this and demand the changes; I hope we’re all up for it. Thanks for a great post Karen.

    1. Thanks for giving real confirmation of the differences, Anna. There’s nothing like a report from the front lines to bring home both the differences, and the need for change.

  7. Thank you for all this important information, Karen. I learned a lot. I sometimes think I am still immortal and need to pay more attention to information like this!

  8. Thank you, Karen, for an insightful post and the report. The tag line is brilliant! Many years ago, I was at a 2-night work conference during the winter. There was a snow storm so attendance was lower than expected. One of the women who stayed overnight went to her room to rest. Her room mate came back to tell the group that the woman complained of sweating, and discomfort in her left arm. I had taken a CPR/ First Aid course at that time. The minute I overheard the symptom description, I immediately thought of a heart attack. We went to the room to check on her and called for help. It turned out that she did have a heart attack, and had to be hospitalized for quite a while post-conference. The strange thing was that her husband had a heart attack several months prior, and some of the people in the group also had spouses who had heart attacks but when I first suggested that it could be a heart attack, everyone was playing down the possibility until I urged to call for help. I did feel outnumbered by the group’s reaction but boy, I was glad I took the CPR course and stuck to my gut instincts.

    1. Hi Natalie,
      What a scary experience. I’m so impressed that you stuck to your guns. I’m afraid I would have caved under the peer pressure. Not only did you potentially save the woman’s life, but I’m sure you permanently changed the mindsets of every woman there. Way to go!

  9. Karen, Thanks for the reminders. Knowing the early-warning symptoms of a heart attack (or a stroke) is critical for everyone, and even more so as we get older and these issues become even more prevalent. I’ve called 911 on my husband twice because we thought he was having a heart attack (neither was, but scary since he lost consciousness both times & had heart attack symptoms). Yet, even last night I discounted pain in my jaw….now I’m wondering if I’m having early warnings on me?!? Or just stress since I carry my tension in my neck. I guess I’m still worried about being “chicken little” when it’s not really anything. (And there are none of the other symptoms… if any of the others surface, I will repost!!)

    1. I’m not surprised you’ve called for your husband twice, Pat. Losing consciousness is nothing to mess around with, heart attack symptoms accompanying that or not!
      I do understand the chicken little thing. When I was much younger I was, for a few years, Ontario’s public education coordinator for the Canadian Cancer Society. One day, very early in my tenure, I pulled the doctor who was the volunteer head of our education committee into my office, closed the blinds, and stripped off my shirt. My breasts were sore and I was convinced I had breast cancer. The doctor – a female- was very kind. She told me what I had was medical student syndrome, believing that everything I studied was happening to me. As it turned out, I’d been finishing grading essays for a teaching assistant position I held at the university and had been carrying heavy bags of essays over both shoulders. Hence the sore breasts which, as you know, isn’t a sign of cancer anyway.
      A little embarrassing, but we do need to get past that right, Pat? Gee you carry stress in your neck. Do you really need me to say me too? This is getting so wild. We really must meet.

  10. Thanks for posting this information. I was aware that the symptoms of a heart attack for women varied greatly from men so it’s a good reminder of what exactly they are. It’s scary that the symptoms can appear to indicate something different (and much more benign) and therefore not cause the alarm they should. My mother died of a stroke so, even though I am in good health now, I try to be alert to changes in the way I feel (I also plan to die…in thirty – maybe forty – plus years, in my sleep, of natural causes).

  11. Hi, Karen – Thank you so much for this very clear and detailed post on such an important subject. My father died suddenly of a heart-attack while I was still a teenager, and my maternal grandmother also died young of heart-failure, so every doctor that I have ever had always takes the time to remind me of the importance of this family history. Still, I have not yet read the Ms. Understood Report (and will correct that immediately). I do agree with Pat and you about women’s general fear of the “Chicken Little Syndrome”. Still, much better to be overly cautious than the alternative. Great post!

    1. Thanks, Donna. I’m so sorry to hear that you lost your dad when both of you were so young. The suddenness of that experience must have been just terrifying. I’m glad you take good care of yourself so you’ll be joining Janis and me in the 40 years +, in our sleep, of natural causes, group.

  12. Thanks Karen for sharing this potentially life-saving information. I have read about the difference in symptoms for women, but have not yet read this report. One time about seven years ago, I was sitting at my desk, when I suddenly experienced a sharp pain in my upper back, along with lightheadedness. I asked a colleague to drive me to the hospital (because I knew the symptoms could be indicative of a heart attack). They kept me under observation and did a bunch of tests, including a stress test a few days later. Although it was not a heart attack, they praised me for coming in. The tests eventually showed that it was another nonlife-threatening problem, which I received treatment for. The temptation is to ignore things like this, but I think it is better to err on the side of caution.


    1. I’m impressed that you went to the hospital with those symptoms, Jude. I have a tendency to write off lightheadedness as simply ‘stress’ and I probably would have done similarly with the pain in the back. It’s so wise of you to have taken your symptoms seriously.

  13. Hi Karen. I agree with all the other comments that we women can’t hear this message enough. I believe that most of us are so accustomed to not putting the “focus” on ourselves that even when we are in life-threatening pain we tend to ignore it or keep it to ourselves. But, the more we are reminded of the symptoms of heart problems I hope the more we will be able to admit if something is going wrong. Thank you for all of us! ~Kathy

    1. Thank you, Kathy. I think I remember reading somewhere that denial can also be a symptom of a heart problem. When that’s combined with the female tendency to focus on other people, it’s a double whammy with serious repercussions. You’re so right that lots of reminders can only be helpful.

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