February is Heart Month and there are lots of messages across multiple platforms on how to be heart healthy. In the past two decades, we’ve seen a lot of attention being paid to heart health and its links to obesity, diabetes and high cholesterol.
The messages fall into three camps: what to eat, how to exercise, and why it all matters. There are multiple diets focusing on optimal cardiac health, an almost equally dizzying array of guidelines on exercise, and tonnes of research on the risks and genetic factors present in 21-century populations.
In more recent years, there’s been significant work looking at women and heart health. We are often misdiagnosed, we don’t get the right treatments, and we are less likely to have the better outcomes. In its landmark report in 2018, aptly named Ms. Understood, the Canadian Heart and Stroke Foundation said the following:
- Heart disease is the leading cause of premature death for women in Canada (dying before reaching their expected lifespan).
- Early heart attack signs were missed in 78% of women.
- Every 20 minutes a woman in Canada dies from heart disease.
- Five times as many women die from heart disease as breast cancer.
- Two-thirds of heart disease clinical research focuses on men.
- Women who have a heart attack are more likely to die or suffer a second heart attack compared to men.
Why this matters became even more critical this year when the the Foundation released a new piece of research demonstrating the link between heart disease and increased rates of dementia. The report (found here as a PDF) says its research “mapped the connections between heart, brain and mind diseases and conditions for the first time and found even stronger links and a much greater impact than anticipated. People managing these conditions are overwhelmed and the system is overloaded. This is a crisis and it is not sustainable. We need to find solutions now.”
So we know what’s happening, and we know what we are supposed to do. But are we actually doing the work we need to prevent and reduce the risks? Well, there is another piece of research, this time at the University of Alberta, which challenges some of our assumptions on the messages we use in promoting heart health. Says one of the co authors, Tami Oliphant: “Women are told they need to exercise more, they need to lose weight, they need to be social and all these heart-healthy activities, but we found that these messages made the women feel guilty, like they had caused their heart disease,”
We know we should reduce the stress we feel, but hey, women deal with a lot of stress. Reducing it isn’t necessarily an easy option. Many of us can’t afford some of the more common stress reducers recommended to women. And then there is the social pressures women face in keeping family and community together, let alone taking time for themselves.
While I am a big fan of the concept behind putting my own mask on first so I can help others, it’s a bit of a juggle and for some, a bit of a fight. Not being able to meet those recommended guidelines can pile on guilt which leads to more stress, etc etc etc.
The research at the U of A suggests we tailor our health messages to the needs of different audiences. That means creating different messages for women compared to men.The symptoms for heart attack in women are different, so the messages building awareness have to differentiate between male and female experiences of cardiac disease to be effective.
It also means letting women know what the alternatives can be for reducing risk. As one of the researchers noted, if you hate running and you can’t find something else in the “sports” field to get your 150 minutes of cardio in a week, what else is there? Ordinary activity for one. Vacuuming is a form of activity and while it may not help you run marathons, it does keep you moving.
The most positive aspect of this focus on women’s experience of heart disease is the empowerment of women. For quite a long time, we have not had control of many aspecs of our health, especially reproductive health. Researcher Oliphant said: “Women’s bodies are perceived as problematic, post-menopausal, whereas when you’re treating men for heart disease it’s about efficiency and getting them back up to speed. So women are diagnosed later, they delay treatment, they can be disbelieved and sometimes they’re even discouraged from seeing a health-care practitioner.”
There is some work on understanding the experience different groups of women will have with heart disease. What else can we be doing to support heart health in women beyond the healthy weight, be active, live smoke-free messages?