A century ago, people grappling with heart disease often felt hopeless, confined to bed rest, or facing early death. We knew even less about how heart issues affected women – simply because nobody gave it too much thought.
Heart disease was long perceived as a condition affecting primarily men, sidelining the health concerns of women; these attitudes persisted throughout the 20th century, a period where discussions about women’s health often revolved around superficial concerns rather than the vital issues of heart health.
Previous studies fell short in properly evaluating the differences in heart disease between genders due to the inadequate representation of women in research studies. It took nearly reaching the turn of the century for hints to surface that women, just like men, women are confronted with significant risks from heart disease and it wasn’t until the mid-1980s that attention shifted towards understanding the potential impact of heart disease on women.
In 1989, it became NIH policy to include women in their funded research, a move that was solidified into law in 1993. However, despite this progress, the prevention and treatment of heart disease in women still heavily relied on evidence gleaned from studies primarily involving men. Clinical trials often excluded women because their symptoms and signs didn’t match the assumptions about cardiovascular risk factors. In 2001, a report from the Institute of Medicine, now recognized as the National Academy of Medicine, shed light on the lack of female representation in clinical trials and the biases in medical practices based on sex. This report urged for a deeper comprehension of how diseases affect men and women differently, prompting a call for sex-specific clinical trials. These enabled researchers to concentrate solely on how cardiovascular disease manifests in women. And what’s striking is that these risks often started much earlier in life for women – heart disease resulting from narrowed heart arteries is more intricate and exhibits distinct behavior patterns in women compared to men, with symptoms that could be different from those experienced by men. Healthcare professionals were also found to be less inclined to advise women on reducing their cardiovascular risk factors, such as losing weight, adopting a healthier diet, or increasing physical activity. Additionally, women were less frequently referred to cardiac rehabilitation after experiencing a heart attack or undergoing bypass surgery compared to men.
A new picture
Women required improved access to information to empower them in making their own health decisions. In response, the AHA launched Go Red for Women, a nationwide initiative aimed at raising awareness about heart disease and stroke as the primary causes of death among women, while also advancing research on the gender-specific aspects of heart disease. Though, even in 2019, only 44% of women identified heart disease as their top cause of death, with many unaware of the signs and symptoms of a heart attack. This lack of awareness was particularly pronounced among young women, as well as Hispanic and Black women, who experienced the most significant decline in awareness. Additionally, a survey revealed that 70% of physician trainees felt they lacked sufficient education in gender-based medical concepts during postgraduate training. Furthermore, only 22% of primary care doctors and 42% of cardiologists expressed feeling extremely well-prepared to assess cardiovascular risks in women.
Studies indicate that women still receive inadequate treatment for cardiovascular issues compared to men. They are less frequently prescribed statins for high cholesterol management, despite evidence showing their efficacy in reducing the risk of heart attacks and strokes. Additionally, women are less likely than men to be given blood-thinning medications for preventing or treating blood clots associated with atrial fibrillation (AFib).
Although there may have been setbacks in awareness, there has been significant progress in recent decades towards comprehending the distinct cardiovascular risks that women face. As we celebrate Women’s History Month in March, we aim to honor the invaluable contributions women make, with a special focus on heart health and with a mission to equip more women with the knowledge they need to take charge of their heart health.
Sources: https://www.heart.org/en/news/2024/02/09/the-slowly-evolving-truth-about-heart-disease-and-women
