The Gender Gap

"Women often have atypical heart disease presentation and often present later in the disease spectrum. Medical treatments also have different effects on women and men."
"[This new study should] highlight the need for further research to understand these differences and to improve care and outcomes in women."
Dr. Louise Sun, anesthesiologist, researcher, University of Ottawa Heart Institute

"Unfortunately, we have seen almost no advance in the strategy used to treat the heart failure that affects women predominately."
Dr. Lisa Mielniczuk, co-principal study researcher, Ottawa Heart Institute

When women present with difficulties in their health condition exhibiting symptoms unfamiliar to medical specialists whose education and practise traditionally reinforces male-presented symptoms linked to heart disease, women frequently are labelled with respiratory problems rather than heart problems in seeking treatment. Women tend to be older when their symptoms appear and because they are older often have other chronic illnesses at diagnosis, thus rendering diagnosis even more fraught.

Women, to begin with, tend to suffer from a variant form of heart failure, different than what afflicts men, and so their symptoms become more difficult to diagnose. To complicate matters further, once they are diagnosed, and treatment proffered, that treatment tends to be less effective for women than it is for men. Though treatments for the type of heart failure common to men is making great strides, the same cannot be said for protocols involving female treatment.

All this to explain why it is that women are likelier than their male counterparts to be hospitalized and die as a result of heart failure. Two investigators at the University of Ottawa Heart Institute recently completed a study published in the Canadian Medical Association Journal; the latest such study to recognize the existence of a gender gap in heart disease presentation, diagnosis and treatment failing the needs of women.

These simple facts appear to explain why it is that women die more often than men with misinterpreted symptoms of heart failure, a chronic progressive condition where the heart muscle is no loner capable of pumping sufficient blood to meet the needs of the body. Outcomes for women are worse despite the fact that survival rates have long been known to be troubling for women since women display different symptoms than do men, yet they receive immediate and appropriate treatment less often.

As a major cause of illness and death, heart failure accounts for 35 percent of female cardiovascular mortality. Hospitalization rates for men with heart failure has decreased, as death rates due to heart failure continue to decline. On the other hand, hospitalization rates for women increased between 2009 and 2014, the period studied by the researchers. In their research, data linked to over 90,000 patients diagnosed with heart failure in Ontario during that time frame was studied.

All of the patients were not hospitalized at the time of diagnosis, and the women identified in the study, representing 47 percent of the patients, tended to be older and frailer, with lower incomes and with multiple chronic illnesses besides their heart symptoms. In the one-year window after diagnosis, 16.8 percent of the women in the study died, while 14.9 percent of men did so. Hospitalization rates for women were higher among women than for men, with 98 women per 1,000 hospitalized in 2013 compared to 91 per 1,000 men.

The goal of the study itself was, according to the researchers, to raise awareness in general that heart failure is quite common within the general population -- as well as to emphasize the phenomenon of gender discrepancies, in the hope of motivating other researchers to engage themselves in similar research which may result in solving some of these gender-specific problems in health symptoms, diagnoses and treatment.

Heart disease and stroke is the number one killer of women around the world, accounting for more deaths every year than all cancers combined

Surprised? There’s more.

• Heart disease and stroke are a leading cause of death among women in Canada, claiming 33,000 lives each year.
• Women are 16 per cent more likely than men to die after a heart attack.
• That number rises to 50 per cent if you just look at the first year following a heart attack.
• In Canada, stroke kills 36 per cent more women than men.
• Nine in 10 Canadian women have at least one significant risk factor for heart disease and stroke.
• Many women are unaware of these risks and how to manage them.
• Many women ignore their symptoms until it’s too late.
• Women can reduce their risk of heart disease and stroke by as much as 80 per cent by managing risk factors, which include eating a healthy diet, being physically active, being smoke-free, limiting alcohol, maintaining a healthy weight, and reducing stress.

Why does this heart health gender gap persist? And how can we do a better job of preventing, diagnosing and treating heart disease in women?
heartandstroke.ca