Women and Heart Disease – Part 1
Men and women do not always experience serious heart problems in the same way. Women’s lives are being put in danger as a result, says Enable Law lawyer Laurence Vick.
Until only very recently the standard model of health was an adult man. The typical heart patient, said 19th century Canadian physician William Osler, was “a keen and ambitious man, the indicator of whose engine is always ‘full speed ahead’,” a man “from 45-55 years of age, with a military bearing, iron-gray hair, and a florid complexion.”
It was only in the 1950s that heart disease was linked to diet, exercise, and other physical factors rather than emotional causes – and even then it was regarded as mostly a man’s condition.
We’re only beginning to recognise the scale of the gender imbalance in a host of critical areas. In 2011 it was noticed women were more likely to be seriously injured in car crashes. The reason? Safety features were optimised for adult men. In the same year the US finally introduced ‘female’ crash test dummies as standard.
The same blindness to gender imbalance still exists in heart care. Last year a University of Leeds study concluded over 8,200 women in England and Wales could have survived heart attacks in the last decade had they been given the same quality of treatment as men.
Twice as many women die from heart disease than breast cancer, but American research suggests only a minority of women know their risk and less than half of medics think of heart disease as a woman’s top concern.
Even adjusting for age and underlying factors, women in the UK are more than twice as likely to die in the 30 days following a heart attack than men.
Conscious or not, informal cardiac terminology can be exclusive. Naming a kind of heart attack the “widowmaker” doesn’t suggest a diagnosis for female patients to fear – although they can suffer it.
As I will cover in my following blog, women are more likely to receive sub-optimal care during and after an acute cardiac event. And women who survive a heart attack are more likely to suffer complications.
‘Normal’ is ‘not normal’
The classic symptom of a heart attack in men is severe chest pain, and this is often the way heart attacks are portrayed in the media – the so-called “Hollywood heart attack”. But in women a heart attack can be quite different: shortness of breath, extreme tiredness, a feeling of tightening and discomfort in their arms, abdomen, neck and jaw, sweating and nausea.
Yet despite these symptoms being fairly common in women, they are still referred to as “atypical”.
A University of Leeds study of 600,000 heart attack patients found women are 50% more likely to be misdiagnosed when suffering one – because they are less likely to suffer male symptoms. Warning signs are more likely to be misunderstood or missed, and often attributed to psychological factors like anxiety or depression.
There have even been reports of women having to ‘sell’ the idea to medical professionals that they might be suffering from a serious condition.
Women also have a different risk profile. Around a third of young women who suffer acute heart attacks have a history of pregnancy disorders such as gestational diabetes or hypertension. Scarcely male-pattern concerns.
University of Oxford analysis of the treatment of 12 million people concluded women were being undertreated for diabetes – a known heart disease risk factor. They were not given the same levels of medications as men and were less likely to receive intensive care.
Women are still dramatically underrepresented in clinical trials for coronary heart disease and heart failure. An estimated two-thirds of heart disease and stroke research was only conducted on men.
Just like our pre-2011 crash test dummies, the assumption is that what works for men will work equally well for women when that is not always the case.
On that theme, women may be given drugs which – either in themselves or at a particular dose – are inappropriate and/or involve a risk of adverse reactions. As an example, one commonly-prescribed drug for high blood pressure which reduces heart deaths among men increases them for women.
These shortcomings in care have medical and legal implications for the NHS. Misdiagnosis and delayed diagnosis, at the cost of effective early treatment, results in additional cost for the NHS – quite apart from the obvious human cost to the patient.