Heart disease continues to be the leading cause of death in the world and a new report suggests women are particularly vulnerable.
A study published Monday in the American Heart Association’s flagship journal Circulation found that women face a 20% increased risk of developing heart failure or dying within five years after their first severe heart attack compared to men.
Researchers from the Canadian VIGOUR Centre at the University of Alberta analyzed data from more than 45,000 patients hospitalized for a first heart attack between 2002 to 2016 in Alberta, Canada. Patients were followed for an average of six years and more than 30% of the group studied were women.
The study focused on two types of heart attacks: a severe, life-threatening heart attack called ST-segment elevation myocardial infarction (STEMI) and a less severe type called Non-STEMI, which is more common among patients.
Heart failure remained higher for women than men for both types of heart attack during hospitalization and also after discharge. Women also had a higher rate of death from the more severe heart attack compared to men.
“We’ve known for a long time that women continue to unfortunately have less aggressive care … We’re doing better but the gap still exists,” said Dr. Leslie Cho, a cardiologist at the Heart, Vascular & Thoracic Institute at the Cleveland Clinic. “This study just confirms that unfortunate finding.”
Experts say both patients and clinicians must do their part to overcome disparities in heart disease from prevention to diagnosis to rehabilitation.
Dr. Eugenia Gianos, director of the women’s heart program at Lenox Hill Hospital in New York City, said women are less likely to take the necessary steps to prevent heart disease such as seeing the doctor to check cholesterol, blood pressure and glucose levels.
“Women, being care providers, tend to be more likely to put the health of their children, their families, before theirs and not be as aggressive about their own health in terms of seeing physicians and also in terms of taking the time for the more heart healthy behaviors like exercise,” Gianos said.
At the same time, clinicians are less likely to look for early risk factors, as most women present symptoms of heart disease later in life. In the AHA study, women were more likely on average to be 10 years older than men at the time of their first heart attack, 72 versus 61 for men.
This is because the protective cardiovascular benefits of estrogen wanes in older women during menopause. The American Academy of Cardiology says high estrogen levels in women help protect the heart by increasing flexibility of blood vessels and arteries, allowing them to accommodate blood flow.
“Very often clinicians will wait until a woman is in menopause to even start treating these risk factors for heart disease,” Gianos said.
The gap also exists in diagnosing a heart attack. Experts say women are more likely to delay seeking care during a heart attack, mistaking symptoms for less life-threatening conditions like acid reflux.
The AHA says women’s most common heart attack symptom is chest pain, but they’re also more likely to experience other symptoms such as shortness of breath, nausea or vomiting and back or jaw pain.
Gianos said some clinicians also are at fault for misdiagnosing these symptoms. According to the study, women were seen less frequently in the hospital by a cardiovascular specialist compared to men, about 72% versus 84%.
“A woman coming into a clinic perhaps doesn’t fit the typical profile of a man clutching his chest that physicians learned about in medical school,” Gianos said. “They need to overcome that medical bias to perceive and understand that a woman is just as high of a risk as a man coming in with those symptoms.”
After surviving a heart attack, Cho says women are less likely to follow through with medications and enroll in cardiac rehabilitation. The AHA says rehab usually consists of exercise counseling and training, education of heart-healthy living and counseling to reduce stress.
And while women are less likely to complete their therapy, physicians also are less likely to prescribe it. According to the study, fewer women were prescribed medications such as beta blockers or cholesterol-lowering drugs regardless of whether their heart attacks were the severe or less-severe type.
Dr. Gregg Fonarow, chief of Division of Cardiology at the University of California, Los Angeles, says the most shocking part about these disparities is the fact that they still exist despite decades of cardiovascular research. He hopes attention to this study will push female patients to take steps to improve their heart health and remind clinicians to double-check their biases.
“Over time, we’ve really not seen improvements in the difference between men and women here,” he said. “(This study) is an urgent call to action to address these differences.”