Making Heart Disease a Women’s Issue

new heart picIn the past two months, two of my friends–both seemingly healthy women–became unlikely victims of cardiovascular disease. One, a woman who by any textbook definition would be considered at low risk for heart problems, nonetheless suffered a heart attack. Thankfully, she is recovering. The other, a longtime friend and a mentor of mine, tragically passed away after suffering a stroke. These experiences left me wondering how we can accelerate efforts to reduce cardiovascular disease risk and mortality in women.

As a women’s health researcher, I am concerned about how long it is taking to bring attention and resources to this problem. After all, it has been decades since we’ve learned that cardiovascular disease affects women every bit as much–or even more–than it does men. Indeed, since 1984, cardiovascular disease has killed more women than men in the United States. When it comes to women’s health, cancer gets a good deal of the attention; somehow, it hasn’t fully registered that so many of our mothers, sisters, friends and daughters are being affected by another, often silent killer.

Commonly referred to as heart disease, cardiovascular disease includes both heart disease and other vascular diseases. When tallied separately, stroke is the third leading cause of death among women. Both strokes and cardiac events are all too common in women over 40 and, sadly, so are deaths.

Consider a few statistics:

  • In the U.S., women account for 60 percent of stroke deaths, and 55,000 more women than men suffer a stroke each year.
  • Worldwide, heart disease and stroke kill 8.6 million women annually–accounting for one in three deaths among women.
  • Whereas one in seven women develops breast cancer, more than one in three women has some form of cardiovascular disease.

Although the American Heart Association’s Go Red for Women campaign has done much to raise awareness, there is still too little attention devoted to preventing heart disease in women and improving the quality and outcomes of their care.

While we should celebrate the significant improvements in the care and survival of men with cardiovascular disease, those gains began decades ago, and the death rate among men has fallen more quickly than it has for women. Unfortunately, women continue to face lower rates of diagnosis, treatment and survival. The new Million Hearts campaign aimed at preventing a million heart attacks and strokes by 2017 has partnered with WomenHeart, a national coalition for women with heart disease. This effort is essential and represents progress, but prevention is not the only challenge.

Why are outcomes worse for women? Even if biomedical research on cardiovascular disease had not traditionally focused almost exclusively on men, these conditions would likely still be harder to recognize and treat in women. Women don’t tend to have the “TV heart attack”–the familiar image of a man clutching his left arm or his chest in pain. Rather, for women, the symptoms of a heart attack are often more subtle and less specific. Women can present with symptoms like throat pain or a sore back. In fact, 64 percent of women who die suddenly from heart disease had no previous symptoms at all.

Furthermore, tests that are mostly reliable in assessing men’s cardiac risk are not as accurate in women, largely because they are aimed at identifying major coronary artery blockage. At least half of heart attacks in women are caused by coronary microvascular disease, which involves narrowing or damage to smaller arteries in the heart. This not only makes the diagnosis challenging, but it poses problems for treatment as well. Women often go undiagnosed or incorrectly untreated after major blockages have been ruled out, and optimal treatment of microvascular disease remains unclear. Consequently, 26 percent of women over age 45 will die within a year of having a heart attack, compared with 19 percent of men. The deficits in women’s cardiovascular care may have developed unintentionally, but our efforts to address them need to be both intentional and focused.

Fortunately, we know what it will take to close the gap and get women better diagnosis and treatment for cardiovascular disease. We can start by looking to the fight against breast cancer. Our first task is to call for increased public and private funding for public-health, biomedical and health-services research to reduce women’s risk and improve their outcomes. Second, on the private side, there are many foundations dedicated to addressing cardiovascular risk in women. But they and the women they serve would benefit from more collaboration and better coordination of effort. Finally, doctors and medical clinics need to do more to improve assessment and the quality of women’s cardiovascular care. Otherwise, women’s care and outcomes will continue to lag behind men’s.

Our bodies are complex systems. So, if we want to take on women’s health in a way that truly moves the needle on outcomes, we need a comprehensive approach. Women’s health care in general needs to become a primary focus for research and practice. And improving women’s health and longevity will require us to expand our focus beyond sex-specific reproductive cancers and predominantly female diseases, such as breast cancer. This doesn’t mean that we should divert resources from other areas of study, of course. But we need to recognize that woman-specific health care should not be confined to conditions that don’t (or don’t often) affect men.

The stakes for women are high, but we can and must bring greater attention to women’s cardiovascular health. Personally, I am not willing to let go of another friend, colleague or relative to a condition that could have been caught and treated if women routinely received appropriate preventive care, diagnostic testing and treatment.  It’s time for feminists to take on heart disease as a women’s issue.

 

Chloe Bird is a senior sociologist at the nonprofit, nonpartisan RAND Corporation.

Image from Pixabay user Geralt via Creative Commons

Comments

  1. Thanks for tackling this topic, Chloe. My battle with heart disease began at 18 years old when I was diagnosed with arrhythmia and then took a turn for the worse at 25 when I was diagnosed with cardiomyopathy (heart failure). I’ve made it my mission to promote awareness for heart disease as a heart coach, advocate and co-founder of the WomenHeart of West Los Angeles support group. Unfortunately, the statistics are only getting worse. Heart disease kills more women than all the cancers combined. If that doesn’t make your readers perk up a bit and educate themselves, I’m not sure what will.

    • Chloe Bird says:

      Amanda,
      Thank you for taking on this issue. I’d be happy to meet sometime and discuss the issue further.
      Chloe

  2. Stephanie Mannon Grabow says:

    I so agree. Thanks for bring this to the front.

  3. Diane Gottheil says:

    A very important statement that should be read by a wide audience!

  4. Thank you Chloe, for this excellent post and reminder of the devastating impact cardiovascular disease has on women. I will add one more bullet point to your list: cardiovascular disease is the leading medical cause of maternal death in the US and California. Our organization, the California Maternal Quality Care Collaborative (www.cmqcc.org) is working with the CA Department of Public Health to investigate these deaths and we will be producing a toolkit for maternity care clinicians and others who care for pregnant and postpartum women that will help them better recognize and respond to signs and symptoms of heart disease. Often, these symptoms are discounted as they mimic typical complaints of late pregnancy, like tiredness, shortness of breath, swelling and anxiety. Our data shows that a good percentage of these maternal deaths are preventable. We look forward to working with you and others to help raise awareness and find advocacy partnerships to collaborate on educating and informing women and health care professionals. Thank you for your work in this area.

    • Christine,
      You make an excellent point. Much of the maternal risk is among women with diabetes, but not all. This is one of the reasons behind the preconception health movement aimed at getting women to know their risk factors and to take on positive health behaviors before getting pregnant or during pregnancy. Good prenatal care is critcal to Moms and their babies to be.
      Thank you for raising these critical issues.
      Chloe

  5. Stephanie and Diane,
    Thank you for the positve comments. I continue to do research in this area and look to ways to improve research and policy to close the gaps and improve women’s health outcomes.
    Chloe

  6. Well said! I have a question: while it is the ideal that all forms of disease be eliminated, it seems wise to focus efforts where we can do the most good. Clearly women’s cardio-vascular disease is a great target. I may have missed it, but are there concrete goals for reducing mortality caused by cardio-vascular disease in women? For example, would our resources be best spent on developing better diagnostics for micro vascular symptoms? What age range contains the most preventable deaths? You did a wonderful job explaining the problem, can you or other commenters point towards the most pressing or viable issues to tackle first in women’s cardio-vascular health?

    • I would love to do work assessing these issues David. There are multiple additional questions to consider including what would be most cost effective and what would result in the most years of life saved or years disease free, and so on. At this point, there are many questions to consider. One finding in my own research is that there are disparities in treatment even among women with insurance, a regular provider and a history of cardiovascular disease. So one logical step would what contributes to those gaps in care. For example do women have more problems with side effects of the treatments (as is often the case), or are there problems with interactions with other medications (as women typically have more comorbidities and are thus on more medications.
      Personally, I would like to see a lot more invested in prevention because diabetes – the leading risk factor for cardiovascular disease raises women’s risk more than men’s. Unfortunately , the obesity epidemic has contributed to a rapid rise in diabetes and the long term consequences are serious.

  7. Jessica Hitchcocck says:

    Great article, Chloe!
    We know that the lifesaving interventions we have now need to be initiated as soon as possible after a heart attack or stroke. Unfortunately, women often have “atypical” or no symptoms. Prevention, recognition of symptoms, diagnosis and treatment of CVD are all more complex in women, although it may only seem that way because our current knowledge relies mostly on studies performed on men. As we take on this challenge and collect more data on all areas of women’s cardiovascular disease, I suspect interesting patterns will begin to emerge.
    Thank you for bringing focus to this health challenge.

  8. Jessica, you raise excellent points. We also need to consider that while we’ve spent years worried about men not seeking care for fear of being the worried well. However, it turns out that women don’t seek care because they don’t want to be any trouble. The first thing they say to paramedics if they do call because of CVD symptoms are “I hate to bother you.” And as mothers, wives, caregivers and so on, we all too often consider whether to seek care at night because of the disruption it will cause (for the family and the next day and so on). What’s more since many of women’s symptoms can also be attributable in part to stress or anxiety, women all too often minimalize their symptoms if they subside and either don’t see regular outpatient care thereafter, or report them and at the same time explain them away. That said, all too many women report having had their symptoms of angina dismissed repeatedly before having a heart attack or other cardiovascular “event”.

  9. This is a great topic. My partner (female) had a heart attack and absolutely none of the ‘risk factors’. We have had to learn a lot, and worked with a Naturopathic Physician even while she was in the ICU. I think women need to know about the VAP test, which measures the particles of cholesterol in the blood. If your particles are big and fluffy they do a better job of clearing out sticky cholesterol. If the particles are small they pack in, creating blockages. This information is far more useful than simple #’s of LDL, HDL, etc. Probably needs to be a baseline instead of the other, actually. It provides the context for those #’s.
    Also, the Naturopath was able to provide nutritional support, which the western dr. didn’t have a clue for, especially since her #’s were all excellent. All the advice is predicated on the list of risk factors and when those aren’t present they really didn’t have much else to offer. Thank goodness for Eastern Medicine. She is healthy and works out 6 days a week now, no further problems. It’s been 3 years since the initial heart attack.
    I really don’t think I’d be saying that without the expertise and ongoing support from Eastern Medicine. Too bad the cardiologist missed the opportunity. I would suggest that might be another front in this campaign, to take the stigma off Osteopathic and Naturopathic Doctors. Western medicine does not train doctors in nutrition at all, and with chronic illness it needs to be brought in front and center. It doesn’t have to be so hard.
    Not to mention the cost, which we have borne completely and continue to do so. No need for that to be so hard either.
    Thanks to all and I know real change is possible, let’s do it!

  10. I am glad your partner is doing well and that you found a combination of Western and alternative providers to address the many relevant issues. You are absolutely correct that most allopathic doctors have rather limited training in nutrition. I look to nutritionists to address that gap. But alternative medicine is also helpful and we are fortunate to have ostepathic providers fairly widely available now in the US. I also appreciate the benefits of other aspects of complimentary and alternative medicine including acupuncture. We are in an interesting time for patients in which there are many paths to consider and evaluate in seeking both preventative and restorative care. There is also a need for futher study to better understand the differences in the types of care men and women are seeking and utilizing and the outcomes they experience.

  11. Thank you so much for this article. I’m a firm believer that research, acceptance of women’s heart disease as “real” (or normal, may be more accurate), and provider education at every touch point along the way from EMS to ER to cardiologist office will reverse the trend we see in death from heart attack and stroke in women. For me, it took two ER visits over six days to receive care and discover a 90% blockage of my LAD from spontaneous coronary artery dissection.

    We certainly can’t wish away women’s natures and hope we are magically perceived to be more assertive in our health care crises. The system must be built to care for us as the women we are, not the men we aren’t.

  12. What you typed made a ton of sense. However, what about this?
    what if you added a little information? I mean, I don’t want to tell you how to run your website, however suppose you added a title to maybe grab a person’s attention?
    I mean Making Heart Disease a Women’s Issue is kinda plain.
    You ought to peek at Yahoo’s home page and note how they create article titles to get viewers to click. You might add a video or a pic or two to get readers interested about everything’ve got to say.
    In my opinion, it could bring your posts a little bit more
    interesting.

  13. Sarah Thappa says:

    I thought this was a great piece that brought much needed attention and insight to this topic. It’s well accepted that increased education, funding, research, and diagnostics are needed to decrease heart disease in women. However, another way to think about heart disease could be through public health consequences and health economics lenses. In addition to being the #1 killer, heart disease is extremely costly. The economic burden is not only felt on the individual level, but also on a larger scale through government healthcare and disability coverage. As medical costs associated with CVDs continue to rise, education, research, and improved diagnostics could reduce costs by focusing on prevention versus retroactive medical care and drug regimes. Focusing on cost will help to reveal more efficient treatments, which is beneficial for both individual patients and the healthcare system as a whole.
    While there are initiatives to decrease heart disease in women, they need to be more aggressive and potentially even couple their efforts with healthcare reform to sustain a decrease in heart disease in women. There has been a gradual change in education, awareness, and funding to women’s heart disease that I hope continues to grow and gain strength through numbers.

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