Same disease, different outcomes: Heart attack and gender

Amanda Lyons

24/08/2018 2:09:13 PM

The persistent view that cardiovascular disease is a men’s health issue leads to poorer outcomes for women.

Despite a perception that cardiovascular disease is a men’s problem, it is the leading cause of death for women and it is important they are able to recognise the warning signs.
Despite a perception that cardiovascular disease is a men’s problem, it is the leading cause of death for women and it is important they are able to recognise the warning signs.

‘If we were to ask a group of women – and there have been a few trials – what their biggest fears are, breast cancer will often come top of that list,’ Dr Meredith Frearson, a GP with a special interest in women’s health, told the RACGP.
‘But when we look at the sheer impact of [cardiovascular disease], it becomes the biggest health issue for women at menopause and later.
‘And I think that’s often under-recognised by women, and maybe even by some doctors.’
Coronary heart disease, a sub-type of cardiovascular disease (CVD), is the leading cause of death in Australia, for both men and women. Heart attacks are actually the biggest killer of women in Australia, at a rate four times higher than breast cancer, but many women remain unaware of this fact.
Professor Danielle Mazza, head of the Monash University Department of General Practice and author of Women’s health in general practice, explained the unique way that age affects women’s risk of CVD.
‘Women have a different profile in terms of when they develop CVD, [and] that’s impacted by oestrogen and menopause,’ she told the RACGP. ‘So there are generally low rates of CVD before menopause, but then after menopause a very rapid increase in prevalence that actually surpasses men.’
Yet the belief that heart attacks and CVD are ‘men’s problems’ persists. And this compartmentalisation of CVD as a men’s disease can lead to poor outcomes for women, with research showing they are less likely to recognise the symptoms in themselves.
‘There is a notion in the community that heart disease is a men’s issue, which might explain why women present later [than men], because they think, “It couldn’t be a heart attack, I’m a woman”,’ National Chief Medical Advisor for the Heart Foundation, Professor Garry Jennings, told newsGP.
‘So there’s certainly a need for greater awareness [of CVD] among women, particularly for those with risk factors.’
This perception can also apply to medical professionals, with CVD more likely to be misdiagnosed in women than in men.
A recent study by researchers at the University of Sydney revealed measurable treatment gaps at the hospital level, with women admitted with ST-elevation myocardial infarction (STEMI) over the past 10 years in Australia half as likely as men to receive appropriate diagnostic tests and treatment. They were also less likely to be referred for cardiac rehabilitation and prescribed preventive medications upon discharge.
This difference in treatment produced sobering results: women experienced more than double the rate of death and serious adverse cardiovascular events within six months after discharge from hospital than their male counterparts.
Professor Jennings is very concerned by the study’s findings.
‘It is quite a striking difference; particularly as treatment for STEMI myocardial infarction is very protocol-driven and the evidence base is really strong,’ he said.
‘Provided that facilities are available, in terms of angiography suites and 24-hour revascularisation availability, there’s no reason outcomes should be any different for men and women.’
The study presents urgent questions for gendered treatment of heart disease in hospitals. But much work can also be done in primary care to help prevent such hospital presentations occurring in the first place.
Dr Frearson believes that ensuring female patients have regular health checks in general practice, particularly as they grow older, is key to preventive healthcare for CVD.
‘It’s not something women are thinking about so much themselves; they’ll come in to look into a breast lump, but not necessarily to find out their cholesterol level,’ she said.
‘So when women come to see us for something like a routine Pap smear, it’s an ideal opportunity to say, “Let’s also check your blood pressure and cholesterol, look at your family history and talk about diet and exercise”.
‘And that’s one of the real benefits of being a GP; you have the opportunity to look at all those interrelating factors.’
It is also important for patients to learn how to recognise the symptoms of a heart attack, particularly if they are subject to risk factors.
‘Crushing central chest pains are most typical, but it can also be pain in the jaw, pain going down the arms, in the abdomen, in the back, or discomfort in all of those places,’ Professor Jennings said.
While there has been research indicating that men and women may experience heart attack in different ways, Professor Jennings does not believe it is especially helpful to focus on this idea.
‘There is a notion that women are more likely to have unusual symptoms, and the data suggests this is true, although lots of men have unusual symptoms, too,’ Professor Jennings said.
‘So I wouldn’t over-emphasise differences between men and women. I think both sexes need to get to hospital more quickly than they do at present.’
Professor Jennings would also like to boost awareness among healthcare professionals that CVD risk applies to both sexes.
‘Just be aware of heart disease as a potential diagnosis in women, and then treat or manage it just as aggressively as you would in men,’ he said.

cardiovascular disease CVD heart attack women’s health

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