Broken Hearts: How the Heart Attack Gender Gap is Killing Women
There’s a gender gap in medicine, and it’s killing thousands of Canadian women every year.
For centuries, “women’s health” focused solely on pregnancy and maternal health. Recent medical research shows that women experience health and illness differently than men, sometimes with fatal results. One of the most dangerous differences results in the phenomenon known as the heart attack gender gap.
What is the heart attack gender gap?
The heart attack gender gap describes the differences in heart disease and heart attack recognition, treatment, and outcomes resulting from sex or gender. Women are significantly more likely to suffer adverse reactions to heart medications. Doctors miss women’s early heart disease warning signs in nearly 80% of cases. Even when diagnosis rates are equal for men and women, men still receive twice as many heart disease treatments as women. This systemic gender gap in medicine works against women at every stage of heart disease.
Let’s consider two reasonably healthy 55-year-old Canadians (although heart attacks can occur at any age): Margaret and Steve. Simultaneously, they each feel the early warning signs of a heart attack.
Following the thalidomide disasters in the early 1960s, “potentially pregnant” women and girls (anyone between the onset of menstruation and menopause) were barred from medical research. New government regulations came into place in 1996, but women lost 30 years of medical research.
As a result, medicine has only brushed the surface of predominately women’s heart conditions, such as spontaneous coronary artery dissection (SCAD). About 90% of SCAD patients are young, otherwise healthy women. Further, SCAD causes roughly 40% of all heart attacks in women under age 50.
Nearly all medical research focused on men like Steve. As a result, diagnostic criteria, medications, diagnostic testing, and risk analysis are all biased in his favour. Margaret has a strike against her before either of them notice that they’re ill.
Early heart attack signs are missed in 78% of women, despite the signs repeatedly occurring for weeks or months. Pain is the primary sign of heart attack for everyone, but women often describe it in milder-sounding terms, such as pressure or tightness. They frequently also describe other symptoms like nausea, jaw pain, or unusual fatigue.
Angiograms are designed to detect disease in the major arteries—where it typically occurs in men. For women, it often appears in the smaller coronary arteries. Women with normal angiograms are four times more likely to be readmitted for chest pain within six months.
Margaret and Steve each arrive at their local emergency departments complaining of chest discomfort. Steve clutches at his chest and is rushed in for testing; he’s displaying the classic signs of a heart attack. Margaret says it feels like her chest is being squeezed and complains of nausea and breathlessness. Her symptoms are dismissed as a panic attack, and she’s sent home.
Fewer women receive the necessary heart disease treatment within the benchmark times than men. Men receive twice as many heart disease treatments than women—even when diagnostic rates are equal.
With a heart attack, efficiency is a matter of life and death. Every additional minute that passes from when the heart stops beating to resuscitation reduces the chances of survival by 7-10%.
Because Steve was admitted to the hospital immediately, there is a team of medical professionals on hand when his heart stops. They revive him in under a minute. He’ll likely make a full recovery.
Margaret’s heart stops while she’s buying pain relief medication from a convenience store near her apartment. There’s no medical team. Paramedics are on the way, but her life is in the hands of the strangers around her. The shopkeeper performs CPR until the ambulance arrives 7 minutes later. Her survival odds aren’t good.
Scared of Women’s Touch
In Margaret’s case she was at least lucky the shopkeeper jumped in to perform CPR. In many cases strangers are afraid to perform CPR (or perform other life saving measures like use AEDs) on women because they are afraid to touch them or move their clothes. The taboo around touching or going near a women’s chest area and exposing or touching their skin, makes many people hesitate to assist women when they would have no problem assisting a man in the same situation.
Following a heart attack, women are less likely to be on necessary medications, such as those that manage blood pressure or cholesterol. The reasons for this gender gap are unclear: Are doctors not prescribing the medication? Are women not filling the prescriptions? They’re also less likely to be referred to a rehab program and half as likely to attend and complete such programs.
Steve is discharged from hospital with medications to lower the odds of recurrence, a referral to a 14-week rehab program, and information about the importance of a heart-healthy diet and gentle exercise. Margaret never regains consciousness.
To further complicate the issue, many women miss or dismiss their symptoms. Heart disease is the leading cause of premature death for women in Canada, but people still see heart attacks as more of an issue for men. Women of Indigenous, Chinese, South Asian, or Afro-Caribbean descent are at higher risk of both heart disease and poor health outcomes following heart health issues than Caucasian women. Genetic and biological factors combine with social elements to create a perfect storm of risk. The gender gap in medicine is not a fixed width for everyone.
Heart Disease in Women: Know the Signs
While everyone’s experience is unique, there are six primary signs of heart disease leading up to a heart attack. Women experiencing these or a combination of these symptoms should seek urgent medical attention.
Described as pain, pressure, squeezing, fullness, burning, or heaviness
Upper body discomfort
Can present in the neck, jaw, shoulder, arms, or back
Shortness of breath
Difficulty breathing or feeling winded while doing everyday activities
Feeling dizzy, seeing “stars,” feeling faint, or needing to sit or lie down
Upset stomach, vomiting, stomach discomfort, or other digestive distress
Unexplained or excessive sweating, a cold sweat
Attacks Out of Nowhere
Catching the signs of heart disease early, especially in women, is key. Most people believe that these symptoms flare up and present imminently before a heart attack to give warning, but that is often not the case. When a heart attack strikes it usually strikes fast and with no symptoms - other than the victim collapsing, unresponsive, in full cardiac arrest. Unless the people around (if there are people around) recognize this as a heart attack, the victims’ chances of survival are slim.
Medical research is making progress, but there’s still a long way to go to close the heart attack gender gap. In the meantime, there are two steps everyone can take to help save the lives of women like Margaret:
- Learn to recognize the signs of a heart attack. Account for gender or cultural differences in descriptions.
- Use an AED along with CPR. Odds of survival can increase by up to 75% compared to CPR alone. Install them. Learn to recognize them and look for them in an emergency.
For more information on the heart attack gender gap or the gender gap in medicine