Advancing inclusion, equality and women’s health

When you have a heart attack, you need to get an artery open; you have to seek medical attention. So, if women – and some health-care professionals – are not recognizing a heart attack, this is a big problem.
Dr. Sherryn Rambihar

Dr. Sherryn Rambihar,
a Toronto cardiologist, researcher and spokesperson for Heart & Stroke, discusses why heart disease in women is under-diagnosed and the importance of more women-focused research.

How are women’s hearts different from men’s?
From a distance, women’s and men’s hearts look the same, but when we drill down, we see differences in heart disease and how it develops and presents.

Women have smaller arteries. They also lay down heart cholesterol in smaller vessels. This has implications when we diagnose and treat heart disease.

How do risk factors for heart disease differ between women and men?
Many factors are associated with heart disease in both men and women, including lifestyle risk factors such as physical inactivity, unhealthy diet and stress, plus conditions such as high blood pressure.
But in women, certain factors like depression, smoking and diabetes can be more important and more strongly linked to heart attack.

And there are women-specific risk factors. We now understand that complications that can occur during pregnancy, including gestational diabetes, pre-eclampsia and pregnancy-induced hypertension (high blood pressure), can be linked to future risk of cardiovascular illness.

Finally, some conditions experienced by more women than men, such as autoimmune disease, are strongly linked to cardiovascular disease.

How do heart attacks differ in women and men?
When women present with a heart attack, it’s important to know that, like with men, the most common symptom is chest pain.

But women also describe more symptoms. We know that for 53 per cent of women who experience heart attack symptoms, it is not recognized as a heart attack.
Maybe it was epigastric pain (pain in the upper abdomen, below the ribs). Maybe they described their pain differently.

We know in cardiology that “time is heart.” When you have a heart attack, you need to get an artery open; you have to seek medical attention. So, if women – and some health-care professionals – are not recognizing a heart attack, this is a big problem.

Why are women being under-diagnosed?
The tools we use to evaluate someone’s cardiovascular risk were from before women were enrolled in clinical trials. These are old data based on a largely white male population.

For example, these tools neglect high-risk modifiers like pregnancy and autoimmune disease, which are affecting young women and increasing their risk.

How are we going to change this?
Promising advances are coming down the pipeline, but we need more research to develop them.
For example, there are new algorithms to help health-care practitioners diagnose women more accurately. These incorporate women-specific risk factors and address younger women, as well as ethnic factors and vulnerabilities.

Better diagnostic tools are on the horizon but largely still experimental. We need more research; we need funding and support to make this a reality.

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