IT’S a shocking statistic that confirms medical sexism is still a dangerous issue in this country: while men are more prone to heart attacks, women have a higher risk of dying from one.
Described as a ‘stunning’ finding, the U.S. research, published last year and involving more than 2.3 million people around the world, builds on a growing mountain of evidence which suggests that women are at a huge disadvantage when it comes to their heart health.
Shocking figures show this is true despite access to the NHS, which has some of the most cutting-edge treatments available in the world.
Women with cardiovascular problems are 50 per cent more likely to be wrongly diagnosed and less likely to be treated promptly.
They are 34 per cent less likely than men to get an angiogram – a type of X-ray used to diagnose a heart attack – within 72 hours of their symptoms starting.
In fact, the British Heart Foundation calculates that 8,243 women’s lives were lost in England and Wales between 2002 and 2013 because they didn’t receive the same standard of care as men.
Experts have long looked at these statistics with growing alarm as further evidence of medical sexism when it comes to the nation’s number one killer.
Women with cardiovascular problems are 50 per cent more likely to be wrongly diagnosed, according to a study
More than 3.6million women in the UK are living with heart disease – it kills more than twice as many women as breast cancer and more than 30,000 women are admitted to hospital with a heart attack every year.
However, because women’s pain is often underestimated by doctors, a diagnosis can come too late, or when damage has already been done.
But today, experts say there is a controversial but effective solution. Sian Harding, Emeritus Professor of Cardiac Pharmacology at Imperial College London, says: ‘My advice to women is this: if you think you’re having a heart attack, take a man with you to the hospital. It might just save your life.
‘Research shows that women’s symptoms are often not taken seriously by emergency medics, but if there’s a man around to advocate, the patient is less likely to be dismissed.
‘If you’re crying and in pain there might be an assumption that you’re being hysterical, so if you have someone to back you up and say that they’ve never seen you like that, it might just lead to you being taken more seriously.
‘It’s sad we have to say it, but it’s true.’
Medical sexism is real, says Prof Harding, however many male doctors might deny it.
Survival rates are up to three times higher for women treated by a female doctor. Just having more women as part of a clinical team improves how well male doctors treat women, the data shows.
Sian Harding, Emeritus Professor of Cardiac Pharmacology at Imperial College London, says: ‘My advice to women is: if you think you’re having a heart attack, take a man with you to the hospital. It might just save your life’
‘There’s study after study saying there are worse outcomes for women in all sorts of cardiac treatments, from heart transplants to having left ventricular assist devices implanted,’ she adds.
‘Even if women get the same treatment they have worse outcomes afterwards.’
A book, Sex Matters, by U.S. physician Dr Alyson J. McGregor makes clear how women often have trouble convincing doctors how serious their pain is.
The harder a woman tries, the more their reaction is downgraded as ‘typical female behaviour’.
Part of the problem is that women are under-represented in clinical trials – most heart research has been carried out on men or male animals.
‘There is a distinct possibility that women’s heart troubles may need to be treated differently because of their unique biology,’ says Prof Harding. ‘And that needs further research.’
But more pressingly, what is often poorly understood – both by many doctors and by patients – is that women’s risk of cardiovascular problems dramatically increases in mid-life as a result of hormonal changes linked to the menopause.
Before they reach this stage, which usually hits between the ages of 45 and 55, the female sex hormone oestrogen protects against the formation of plaques – inflammation and build up of fatty deposits in the arteries which can lead to heart attacks.
But when levels of oestrogen wane, the protective effect does, too. And while heart problems are often seen as something disproportionately affecting men, the truth is that from midlife onwards women’s risks ‘rise steeply’, and become equivalent to the risks faced by men, according to Vijay Kunadian, a professor of interventional cardiology at Newcastle University.
Prof Kunadian explains: ‘Women often gain weight around this time, partly because the body tries to compensate for the oestrogen reduction with fat cells, which produce a weaker form of the hormone.
‘The way women store fat changes, too. It accumulates around our internal organs, which can cause cholesterol levels to rise and increase the risk of type 2 diabetes.
‘Both high cholesterol and type 2 diabetes increase the risk of heart disease. Blood pressure also increases around this time, which is a huge risk for the development of coronary artery disease – the hardening of the arteries.’
Studies have shown there are other female-specific factors which may also increase your mid-life risk of a heart attack, including fertility and pregnancy disorders such as pre-term delivery, gestational diabetes and polycystic ovary syndrome.
The second problem is that a woman having a heart attack may have symptoms which are not considered typical.
A regular feature of health campaigns which highlight heart attack symptoms is the image of a man clutching his chest in agony while the pain radiates outwards and down the arms.
While there is overlap between the way both sexes experience a heart attack, symptoms can be different in women, Prof Kunadian says.
About 80 per cent of women may experience tightness or heaviness in the middle of the chest, but they are more likely than men to have pain in their back, between the shoulder blades, along with nausea, vomiting and breathlessness. Sometimes, they may just ‘not feel themselves’, she adds, or just experience overwhelming fatigue.
‘The reasons behind the differences are complex,’ says Prof Harding. ‘More women may develop heart attacks due to temporary blockages, when fatty plaques in the heart’s arteries erode. There are likely other biological differences we don’t know about.
‘These differences are why doctors may not suspect a heart attack in a woman when she arrives at A&E, and this delays treatment.’
Women, who can be adept at dismissing their own pain, often misread the signs, too.
‘As clinicians, we’ve seen significant numbers who think they’re having panic attacks, indigestion or suffering a chest infection,’ says Prof Kunadian. ‘They don’t want to bother anyone, and the last thing on their mind is that they’re having a heart attack. So they soldier on.
‘But by the time they come to hospital the damage can be serious, and such delays and misdiagnoses increase the risk of death by 70 per cent.’
The experts’ advice is that any woman going to hospital with any of these symptoms should ‘make sure the team has considered if it might be a heart attack’, says Prof Harding.
‘If you’re being taken by ambulance, ask if you can be taken to a specialist heart attack centre instead of a local A&E,’ she says.
‘The guidelines are clear on the protocol doctors should follow.
‘Patients should have an electrocardiogram (ECG) to measure the heart’s electrical activity and a blood test to check for troponin, a protein released by the heart if it’s damaged.
‘Some patients may also get an angiogram, which involves injecting a dye into the arteries and taking X-ray pictures of the heart to check for blockages.
‘If there is a complete blockage, known as a STEMI, you may need coronary angioplasty, which restores blood flow to the heart by inserting a balloon via a catheter into the blocked artery and inflating it.
‘A stent – a mesh tube that acts as a scaffold to keep the artery open – may also be implanted in a similar procedure.
‘For heart attacks which involve a partial blockage – called NSTEMIs – only medication will be given.
‘Yet women are less likely to get an angiogram or an angioplasty.
‘A study found men have 20 per cent more of these procedures than women and were nearly twice as likely to survive while in hospital.’
Prof Kunadian says women are also less likely to get the recommended medication following a heart attack – and more likely to die in the year following the attack than men.
She explains that the guidelines recommend taking five drugs after a heart attack: antiplatelets, which prevent abnormal blood clotting; ACE inhibitors to lower blood pressure; beta blockers to control heart rate and lower blood pressure; statins to reduce cholesterol; and aspirin, a blood thinner.
‘Check you’ve been given all of them, and if not, make sure the doctor explains why,’ says Prof Kunadian.
There are also cardiovascular conditions which disproportionately affect women but are less likely to be picked up in tests – so-called ‘silent heart attacks’ which can result in them being told nothing is wrong and sent home.
Women often have trouble convincing many male doctors how serious their pain is, according to U.S. physician Dr Alyson McGregor, who says in her book Sex Matters that the harder a woman tries, the more their reaction is downgraded as ‘typical female behaviour’
If an angiogram appears clear but the symptoms suggest a cardiovascular problem, it’s worth knowing that there are other techniques – such as a cardiac MRI, echocardiogram or intravascular imaging – which can be used to investigate further and uncover the underlying issue.
‘If you’re in this situation, and an angiogram is clear but you’re still concerned, ask whether other tests can be carried out,’ Prof Kunadian suggests.
Equally important is taking steps to protect your cardiovascular health in the first place, which can prevent heart attacks.
NHS advice includes eating a healthy, balanced diet based on Mediterranean principles – lots of fruit and veg, lean meat and fish, pulses and legumes, and small amounts of dairy.
‘Limit alcohol and quit smoking – it’s never too late – and exercise for at least 150 minutes a week, which can be a brisk walk but should also include strength exercises,’ says Prof Harding.
‘And all adults aged 40 to 74 should have an NHS Health Check every five years – if you haven’t had one, call your GP surgery and ask for it.
‘This will assess your blood pressure, cholesterol, BMI and blood sugar levels, and can give you an idea of whether you’re at increased risk of a heart attack in the next ten years.’
She adds that high blood pressure is one of the most under-diagnosed heart conditions and the number one risk factor for a heart attack.
‘It’s entirely preventable. If blood pressure stays consistently high, medication can bring it down. But a healthy diet and regular activity are vital.’
But most importantly, both experts say you should always act on any concerns you have.
‘Never ignore breathlessness or pain in your chest, upper back or left arm,’ says Prof Harding.
‘Don’t wait until it’s too late.’
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