Heart disease describes a number of diseases which affect the heart and/or the blood vessels in the heart. Heart disease is one of the leading causes of death in New Zealand for both women and men¹. Men and women experience heart disease differently due to biological and social factors. Despite this, health care practice is largely informed by research conducted from a male dominated standpoint. This means that despite heart disease being one of the leading two causes of death in women, much of the knowledge and understanding of heart disease comes from male-centered research.
Ischemic heart disease
The most common form of heart disease is ischemic heart disease. Ischemic heart disease (also known as coronary artery disease, atherosclerotic heart disease, and coronary heart disease) is a condition where plaque builds up in the coronary arteries. This plaque narrows and hardens in the arteries, which limits blood supply and oxygen to the heart. This can lead to damage of the heart and heart attack.
Why do sex and gender matter?
The World Health Organisation defines sex as “biological and physiological characteristics” while gender is “socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women”². Sex and gender matter in health because each impacts on health and wellbeing. Gender and sex differences in heart disease are evident in the development of conditions, the symptoms, and responses to treatment. These differences are compelling reasons for greater consideration of sex and gender in medical research and practice.
Many people are well aware of the typical heart attack symptoms that men experience, but did you know women often experience different symptoms? Men often experience pain localized to the chest, but women often experience pain elsewhere. Therefore, if you are experiencing pain, discomfort, heaviness, tightness or pressure in your chest, jaw, shoulders, arm, neck, back, upper back, or abdomen you may have had a heart attack. Other common symptoms include sweating, shortness of breath, nausea, fatigue, light headedness, and pain that comes and goes³.
Because people have less awareness about the symptoms of heart attack in women they may be slower or less likely to seek medical attention. People often imagine heart attacks to look different than they often are – therefore, it is important that if you think you are experiencing any symptoms of a heart attack call 111 immediately.
Men and women have some common risk factors for heart disease, however, the significance of these factors can vary between the sexes. For example:
Behavioural factors » smoking as a young adult has a greater impact on women’s likelihood of developing ischemic heart disease than it does for men.
Social factors » social factors contribute to women’s experience of heart disease. Women are more likely than men to live in poverty and are more likely to experience depression and anxiety, all of which are risk factors of heart disease.
Biological factors » diabetic women have a greater risk of developing heart disease than diabetic men. Furthermore, disorders during pregnancy can increase women’s risk of heart disease in the future. Biological sex also impacts on symptoms of heart attack which means women and men may present differently. When heart disease advances to heart attack, women are more likely than men to present with atypical symptoms.
Women in medical research
Even though there are known sex and gender differences in health, medical research often fails fails to adequately investigate or analyse the implications of either. This failing is often present at the initial planning stages of research, when exploring the implications for sex should be built into the experiment. At early trial stages, studies often use male animals or fail to report on the sex of animals used. At the human trial phase, women continue to be a minority, averaging approximately one third of participants in European and US studies. Furthermore, these medical trials inadequately analyse gender. Only half of the European cardiovascular disease trials conducted between 2006 and 2010 included a gender analysis, while in the US only a quarter to one third of mixed-sex NIH-sponsored trials reported results according to sex. As a result, medical research and practice is skewed to the male experience, leaving women at risk for misdiagnosis, sickness and even death.
How can I reduce the risk of heart disease?
Women can take action to reduce the risk of heart disease, including exercising regularly, eating healthily, managing stress, and stopping smoking.
Heart attacks in women » NZ heart foundation’s information page for heart disease in women
Women and heart attacks » British heart foundation
Inequalities in heart attack care ‘costing women’s lives’ » BBC article exploring the inequalities in the treatment of heart disease for men and women
¹Finegold JA1, Asaria P, Francis DP., Mortality from ischemic heart disease by country, region and age: statistics from World Health Organisation and United Nations. Vol 168, September 2013. pp. 934-935.
²World Health Organisation. ‘Gender, Women and Health’. Retrieved from: www.who.int.
³Fields, L. Six Symptoms of Women’s Heart Attacks. Retrieved from: www.webmd.com