Women’s hearts: different doesn’t mean less deserving of attention

The Framingham Heart Study is one of the biggest and longest-running medical studies in the US, and it focuses on heart disease.  It turns 70 this year! It started in 1948, enrolling men and women (mainly husband-wife pairs), and then family members and their descendants. It started enrolling non-white participants in the 90s and has continued to enroll their offspring and descendants.  This project has amassed a huge amount of data to study heart disease and other medical (and some social) phenomena.

Heart disease is the number one cause of death for women and men in the US and the number two cause of death in Canada (cancer is number one). For decades, the medical community believed wrongly that heart disease was predominant in men and less common in women.  This mistaken belief was corrected as a result of research.  However, women with heart disease are still commonly dismissed and left untreated because their symptoms and clinical profiles are different from those of men.

Difference– we deal with difference all the time. Not all things are alike in all ways, so we respond accordingly. Some of my houseplants need a lot of water, and others would die if I watered them often. Here’s the definitive word on watering plants from Better Homes and Gardens:

Some plants need a period of dry soil for days or weeks. Others houseplants need more regular watering, with the soil allowed to dry between each drink. Still others prefer consistently moist soil. Many houseplants go through phases of growth when they require more or less water.

FYI: over-watering is the number one cause of house plant death worldwide. Don’t let this happen to you and yours.

The fact that my plants are different with respect to watering doesn’t mean that some of my plants are standard and others are non-standard.  There is NO standard watering schedule; there are just a bunch of different ways to water, depending on type of plant, soil, humidity, season, etc. We adjust accordingly, and hopefully all goes well.

You would think we would apply this idea to something more important than plants and watering, namely people and their hearts. We know that both women and men get various forms of heart disease (heart attacks, heart failure, etc.), and their symptoms are different. How hard is this to manage?

Apparently too hard. Look at this excerpt from an article in this week’s issue of JAMA (Journal of the American Medical Association)

JAMA: Framingham data found that coronary heart disease symptoms are different in women than in men. Do you think these differences are recognized widely enough by women and their physicians?

Dr Levy: The medical community and the public are not as aware of differences between men and women and the symptoms of heart disease. Men often have a more classic presentation, whereas in women, an early presentation of heart disease may be exertional fatigue as opposed to classic chest pain.

Okay, there are a few problems here.

Problem one: Why isn’t the medical community aware of the differences in symptoms between men and women? Medical professionals deal with difference all the time– children vs. adults, bigger vs. smaller people, people with other conditions vs. people without– I could go on. This information has been around for a long time– long enough for it to have made its way into clinical practice. Claims of ignorance here are no excuse.

Problem two: calling chest pain a “classic” symptom of onset of heart attack, whereas exertional pain is considered non-standard or non-classic is making an implicit value judgment. It’s saying that we automatically investigate further for heart attack for chest pain, but don’t necessarily do so for other symptoms that women also commonly experience, like the following:

Men and women alike can experience the well-known heart attack symptoms like gripping chest pains and breaking out in a cold sweat. But women can also have subtler, less recognizable symptoms such as pain or discomfort in the stomach, jaw, neck or back, nausea and shortness of breath.

Now I’ve got a another problem.

Problem three: why is it that pain in the jaw, neck or back counts as subtler and less recognizable than pain in the chest? Less recognizable to whom? Surely the woman experiencing it is recognizing them and reporting the symptoms, otherwise, we wouldn’t know about them in the first place. What this means is that medical professionals consider those symptoms to be less important as ways to diagnose risk or onset of heart attack. And they would be wrong about that.

So what are we supposed to do about this? The American Heart Association created the group Go Red to try to educate women about heart disease. It repeatedly states that women’s lack of knowledge about heart disease and how their bodies and symptoms are different contributes to increased heart disease death rate among women. It also mentions that medical professionals need to be better educated, and more research needs to be done.  But it ends one page with this call to action:

Women need to become fierce advocates for their own health. So, it’s time to shout louder, ladies. Go Red and make your voices heard so that no woman is left questioning or ignoring her heart health ever again.

Okay, I’ll end with this last problem (for now). So the American Heart Association’s big message to women is that it is their job to advocate for themselves with the medical establishment about getting proper treatment for heart disease? That is NOT the take-home message I get from reading about differences among women and men with respect to heart disease symptoms and physiology. My message is this: