A doctor explains to his female patient that there are studies of fruit flies, mice, hamsters, frogs, monkeys and men with her particular condition — but medical research using women as subjects simply never occurred to anyone.
I came across this cartoon while preparing for a presentation highlighting the gap in knowledge ofheart disease in women, and it accurately represents the state of research today. Very little has changed in the 23 years since the publication of this cartoon in 1990. Heart disease in women is under-researched and subsequently under-diagnosed.
A common belief is that heart disease is a man’s disease. This is completely wrong, as heart disease is one of the leading causes of death in Canadian women, and few women are aware of the risks they face on a daily basis from heart disease.
Forty six per cent of women believe that breast cancer is the most important health issue in women’s lives today, partly thanks to excellent awareness campaigns. Compare this to four per cent of women who think that heart disease is a pressing health issue.
While breast cancer remains an important health issue, heart disease is a silent killer. Heart disease and stroke kill five times as many women as breast cancer. Moreover, in the past decade both hospitalization and deaths due to heart disease have decreased more for men than women.
How can there be such a significant difference in heart disease outcomes between men and women if they have equal access to care and treatment?
Women are routinely under-diagnosed, under-treated and most importantly under-studied when it comes to heart disease. This leads to an undesirable situation where women are unaware of the health problems for which they are at risk, leading to increased death.
Canadian Olympic figure skater and bronze medalist Joannie Rochette lost her mother, Therese, to heart disease two days before she had to compete in the Vancouver Olympics. Months after her mother’s death, Joannie stated that she still feels angry at her mother for not seeking the proper medical attention despite feeling unwell. But would any woman have recognized Therese’s symptoms as heart disease? She had pain in her left shoulder, numbness in her lips and water retention. Her general physician recommended physiotherapy for her symptoms. No one, not even her doctor, saw it coming. This tragedy exemplifies the problems women face with heart disease awareness among both patients and physicians.
Although many women are acutely aware of the risk of breast cancer, few campaigns have trumpeted the risks of heart disease. Studies have found that men generally know more about heart disease than women. A recent poll in the United States found that only seven per cent of women think that heart disease is a major concern for them. Similarly, a 2007 study in New York revealed that family physicians had limited knowledge about the risk factors of heart disease in women. Women tend to have less severe and immediate symptoms of heart disease, which can often lead to delays in seeking care. These factors can lead to under-diagnosis.
In addition to the lack of awareness, women are grossly underrepresented in research trials that examine the development, prevention and treatment of heart disease. Most of the major clinical trials that test the effectiveness of commonly used drugs, such as statins (a cholesterol-lowering drug), consisted of less than 30 per cent women. Due to this underrepresentation, women are often treated based on evidence from trials done mainly on men. This practice is not only ineffective, but potentially dangerous for women.
A recent CBC article, titled “Why heart attack care may be less timely for women,” along with the CBC 60 Minutes episode on women and heart disease, have helped highlight some of the issues of treating women and men using similar medication doses. The episode specifically addresses important problems in research today, such as the fact that most of the studies are done on male subjects and male animals. Once researchers start understanding heart disease in men and women separately, we will be able to close the knowledge gap, and hopefully encourage more women to pay attention to their hearts.
Finally, due to a different set of symptoms of heart disease in men, which are more widely known to the general public, women are less likely to recognize appropriate symptons of heart disease. For example, men often experience extreme pain in their chests, but some women might experience fatigue, nausea and back pain. Researchers are becoming aware of these differences between the presentation of heart disease. Unfortunately, this results in women being identified inappropriately for treatment, and often causes delays and confusion for an issue that requires timeliness and consistency.
The medical community is becoming more aware of the required differences between men and women in the treatment and prevention of heart disease. A greater understanding of these differences among patients, doctors and researchers will help fill this knowledge gap that exists in heart disease, and hopefully save the lives of women in the future.