Talk to most doctors about heart disease for long enough and one phrase is bound to come up: “It’s an equal-opportunity threat,” says Dr. Beth Abramson, a spokesperson for the Heart & Stroke Foundation of Canada and director of the cardiac prevention and rehab centre and women’s cardio division at St. Michael’s Hospital in Toronto. Today, just about the same number of men and women succumb to heart disease and stroke, about 36,000 annually. Yet “when people shut their eyes and think of someone having a heart attack, they think often of a man,” she says. “It’s perceived to be a man’s disease. It’s not.”
In fact, one in three Canadian women will die of heart disease and stroke—compared to one in 18 from lung cancer and one in 28 from breast cancer. By 2050, stroke mortality in the U.S. is projected to be 30 per cent higher for females than males. Despite the staggeringly high risks, the issue is only now gaining widespread recognition. “We noticed [female] patients were so surprised to have had a heart attack,” says Dr. Susan Bennett, director of the women’s heart program at George Washington University Hospital in Washington. The thinking was, “ ‘Everybody was checking my breasts and uterus, but nobody was talking to me about heart disease.’ ”
Every year, Maclean’s features its “How Healthy Are You?” series focusing on the well-being of Canadians. Of the initial 5,100 people who participated in an online survey of overall health called the Q-Gap, which is posted at www.macleans.ca/howhealthy, cardio-respiratory symptoms such as chest pain and breathlessness were the least reported ailments by men and women—even though “these symptoms are known to be acutely exhibited among people with sudden heart and vascular conditions,” says Dr. Elaine Chin, chief medical officer of Toronto’s Scienta Health, which created the test. This may also prove that heart disease just isn’t on a lot of people’s radar, especially among females.
That’s changing. Massive awareness movements are under way: the U.S. Women’s Heart Foundation doles out purple ribbons. Feb. 6 has been ordained “National Wear Red Day” by the American Heart Association. And the Heart & Stroke Foundation has launched “The Heart Truth” campaign—its official symbol is a red dress pin to boost education about female risk factors.
The campaigns are happening at the same time as research is accumulating. Groups such as the Genesis project, which was established in 2004 and is partly funded by the Canadian Institutes for Health Information, are identifying how diagnosis, treatment and perception vary between genders. Already there are stark contrasts. Women usually develop heart disease 10 years later than men, and sometimes suffer atypical symptoms. Congestive heart failure can look different between the sexes—in females, the heart gets thick and small; in males, it becomes enlarged. Women are also up to 30 per cent more likely to drop out of cardiac rehabilitation programs after a heart attack than men.
There’s still a lot to figure out. More than 30 years ago, twice as many men died of heart attack as women. It was a “man’s disease.” But since then, a perplexing trend has been observed: while male mortality rates for heart disease and stroke have been declining, women’s have risen, according to a report by the Heart & Stroke Foundation. Between 1973 and 2003, the number of men who died from heart disease and stroke dropped 19 per cent; during that same period, the number of female deaths rose by five per cent. For the first time in three decades, the mortality gap had closed in. (The latest Statistics Canada data shows the number of deaths from heart disease declining slightly in 2004.)
But over the years, another gap manifested. Because men were the primary population afflicted with heart disease, their way of articulating symptoms defined classic diagnostic criteria. Treatments were established according to how well they worked on men, who until recently made up the majority of participants in clinical trials. All this contributed to a gender bias among the public and health care professionals. Women downplayed symptoms, and doctors under-diagnosed them. Even after a heart attack, females have historically been under-referred to specialists and have had bypass surgery and angioplasty less often than men. One 2005 study showed that only 17 per cent of cardiologists in the U.S. knew that more American women die from heart disease each year than men.
The first step in fighting heart disease is, of course, recognizing symptoms—which isn’t always easy. Chest heaviness or pain is the most common indication of heart troubles among both sexes (along with suddenly feeling cold, clammy or short of breath), explains Abramson, but sometimes women articulate it as “an unusual burning.” Dr. Louise Pilote, principle investigator of Genesis and director of general internal medicine at McGill University Health Centre in Montreal says that instead of pain radiating down the shoulder and into the jaw, which is typical, some women feel it more in their neck and back. Others just experience nausea, dizziness, sleep disturbances or extreme fatigue. These atypical symptoms make diagnosis especially tough because even when a female seeks medical attention, heart disease “is not the first thing you think about when a woman says ‘I’m so tired,’ ” says Pilote.
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