wear red day 2024: women still underdiagnosed and undertreated with heart disease, stroke
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women have their own unique heart disease risk factors and are disproportionately affected by others.
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matters of the heart are not so straightforward, especially for women.
according to the canadian women’s heart health centre, at the university of ottawa heart institute, 24,000 canadian women die of heart disease every year. that’s nearly seven times more deaths than from breast cancer.
the heart and stroke foundation reports that heart disease and stroke is the number one cause of premature death in women in canada and early signs of a heart attack were missed in 78 per cent of women. and women who have a heart attack are more likely to die or suffer a second heart attack compared to men. feb. 13 is “wear red day” in canada to create awareness and push for change.
experts say that increasingly more women will die unnecessarily if the medical community doesn’t change to tailor care specifically to meet women’s needs. it’s still largely a man’s world where women are underdiagnosed, undertreated and unaware.
why?
women themselves delay seeking care and are often misdiagnosed because of the symptoms they develop. think about it: chest pain or discomfort is the most common sign of a heart attack in both sexes, but women are actually far less likely than men to have any chest pain. symptoms can be different than those of men and attributed to stress and busy lives by both physicians and women.
months before a heart attack, for example, women may experience unusual fatigue, trouble sleeping, indigestion and anxiety.
one study, however, found that women complaining of symptoms consistent with heart disease recognition, including chest pain, were twice as likely to be diagnosed with a mental illness when compared to men who presented with identical symptoms.
the symptoms for women can also be subtle during a heart attack, including “indigestion, shortness of breath and back pain, sometimes even in the absence of obvious chest discomfort,” says dr. lili barouch, director of the johns hopkins columbia heart failure clinic. and a report by the american heart association revealed that heart attacks are deadlier in women who don’t exhibit chest pain, in part because it plays out that patients and doctors take longer to identify the issue.
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dr. dylan blacquiere, stroke neurologist at the ottawa hospital and assistant professor of medicine at the university of ottawa, sees patients with acute stroke or bleeding in the brain whose blood pressure may have been uncontrolled for years or other symptoms of cardiovascular disease have advanced.
“heart attack symptoms in women tend to be different than men who have heart attacks. and traditionally research has been done in middle-aged white guys. so knowing how things present in different populations is something that we’ve only started in the last 10 to 15 years to have a good understanding of what specifically that means,” he says.
a group of u.s. scientists in 2022 published a study in therapeutics and clinical risk management that looked at the factors that drive women to delay seeking care for their cardiac problems and found the absence of chest pain was a major reason. many of the women reported having either shortness of breath or nausea and indigestion.
now there’s a growing body of work shining a light on what previous male-focused research has not shown – women have their own unique heart disease risk factors and are disproportionately affected by others:
- relatively high testosterone levels prior to menopause
- increasing hypertension during menopause
- pregnancy complications like gestational diabetes
- autoimmune diseases such as rheumatoid arthritis which is more common in women than in men
- stress and depression, also more common among women
- low risk factor awareness, including lack of recognition of many of the above conditions as risk factors for heart disease.
as blacquiere points out, there are different things that women are more susceptible to as they grow older, for example. “so they may be more susceptible to severe strokes when they’re older because of the presence of atrial fibrillation, or abnormal heartache, because there’s a gender component to that.” women often have underlying valvular disease. and new research from the smidt heart institute at cedars sinai challenges conventional wisdom that men are at greater risk of atrial fibrillation, finding that women have a 50 per cent higher risk of developing it than men.
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women are biologically different. they generally have higher heart rates and smaller hearts and arteries than men. they also have less buildup of plaque in their arteries, and the plaque tends to behave differently. and where male hormones enlarge arteries, female hormones make them smaller, so women’s arteries are more prone to blood clots or blockages and more difficult to repair.
another concern is that more younger women are presenting with classic vacular high-risk factors for heart disease, such as high blood pressure, diabetes and obesity. lifestyle factors play a role here, but what’s becoming more recognized is fluctuating hormones during pregnancy and approaching menopause that impact women’s heart health.
“people can develop hypertension at any age. people can develop cholesterol issues at any age, atherosclerosis in any age. we start to see it in people in their 40s and 50s, but we will see younger ages as well,” says blacquiere, but there’s research advancing the discussion of non-traditional risk factors.
he talks about women age 35 to 55 as more susceptible to autoimmune disease like lupus, and that the chronic inflammation of autoimmune conditions can be linked to vascular issues including the development of blood clots or influencing heart function.
one of the projects he’s working on looks at stroke and blockages in the carotid arteries, the major blood vessels that supply blood to the brain. men respond to one specific therapy for these blockages, but women don’t respond as well. “one of the things we’ve found through our research is that maybe that’s just because this population wasn’t studied, so we need to look at how the outcomes actually match in groups like women to see how they’re affected.”
another example, the university of ottawa heart institute is investigating how women respond to heart failure therapies because women can experience congestive heart failure very differently or present in a different fashion, so there may be more tailored treatments that would provide better survival and better quality of life for women.
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“there’s been a real drive to go back and look at some of the things that we thought were potentially well established and revisit that to make sure that we’re taking into account things like women’s health and women’s presentation to see if the assumptions that we were making aren’t actually true,” notes blacquiere. that trend is fueling optimism in the research community, he says:
“the sheer amount of attention that’s being given to women’s health on this, the fact that it’s starting to become a very important topic of research with its own symposia and its own groups looking into how these conditions behave differently in women and how women may respond to very different therapies or have very specific needs that haven’t been traditionally addressed. that’s the start of providing better care.”
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