Women’s hearts are victims of a system ill-equipped to diagnose, treat and support them, according to the Heart & Stroke 2018 Heart Report issued Feb. 1, a document informed by research from York University Professor Sherry Grace.
Women in Canada are unnecessarily suffering and dying from heart disease because of inequities and biases that have resulted in a system that does not provide adequate medical care, the report finds.
“Heart disease is the leading cause of premature death for women in Canada, yet women’s hearts are still vastly misunderstood,” said Yves Savoie, CEO, Heart & Stroke. “It’s shocking that we are so far behind in our understanding of women’s hearts, and that new knowledge is so slow to reach the bedside.”
The report highlights that:
• A women dies of heart disease in Canada every 20 minutes
• Early signs of an impending heart attack were missed in 78 per cent of women, according to a retrospective study published in Circulation
• Two-thirds of heart disease clinical research still focuses on men
• Women are five times more likely to die from heart disease than breast cancer
• Women are more likely than men to die or have a second heart attack within the first six months of a cardiac event
“Women are under-researched, under-diagnosed and under-treated, under-supported and under-aware,” said Savoie. “It’s unacceptable, and the situation has got to change – we need to smash this glass ceiling.”
The gap in the system goes back to research being done almost exclusively on men for decades, and the assumption that one-size-fits-all clinical guidelines, diagnostic procedures and therapies are acceptable for both sexes and all genders.
Once a woman is diagnosed with heart disease, she may find standard treatments less beneficial and more risky. She is less likely to receive care from a cardiologist, or to be referred for much needed treatments. For Indigenous women who live on-reserve, there is a lack of cardiac care resources in remote or rural hospitals.
Women are also less likely to be referred to cardiac rehabilitation by their doctor, and only half as likely as men to attend or finish a cardiac rehab program.
“Through our research, we found that doctors do not perceive women will benefit from rehab as much as men,” said Heart & Stroke-funded researcher Grace, a professor at York University and senior scientist at Toronto Rehabilitation Institute. “And one in three doctors was not even aware of their own gender bias.”
“There are important differences in women’s hearts that are irrefutable and still poorly understood,” said Karin Humphries, scientific director of the B.C. Centre for Improved Cardiovascular Health. “The types of heart disease that affect women can be quite different from men, and require a women-specific approach to appropriately diagnose and treat.”
Some women are at even greater risk. Coronary heart disease, which can lead to heart attack, is responsible for a 53 per cent higher death rate in Indigenous women compared to non-Indigenous women. Women of South Asian, Chinese, and Afro-Caribbean descent are at higher risk and experience higher rates of heart disease and poorer outcomes.
However, studies show that even though nine of 10 women have at least one of the risk factors, most underestimate their risk.
And a new Heart & Stroke survey of 2,000 women across Canada found low levels of health knowledge combined with high levels of unhealthy behaviors, which put women at even greater risk. Despite this, only one in five said their doctor talked to them regularly about their heart health. Knowledge about heart health was particularly low among young women, visible minorities and women in Quebec.
“This situation is an unintended consequence of a complicated set of factors including how society conducts health research, the time needed to advance scientific knowledge, sex and gender bias, and women’s tendency, as caregivers, to put others before themselves,” said Savoie.
“We urgently need to catch up,” Savoie said. “As a country, we need to change the fact that two-thirds of clinical research still focuses on men.”
Savoie recommends educating and equipping healthcare systems and providers to think about, investigate and treat women’s heart disease differently than they do men’s; and making sure women get the same access to cardiac rehabilitation.
Another important pillar is to support women so they can fully and deeply understand that taking care of others begins with taking care of themselves, and that they are supported by their families, workplaces and healthcare providers in doing so.
The report indicates that while there is still much work to be done, more organizations that fund research are requiring that sex and gender be considered in research proposals, and this understanding is growing among researchers themselves.
Researchers in Canada are at the forefront of new studies into heart conditions that predominantly affect women, but the progress is not fast enough to equitably protect women’s hearts, said Savoie.
Heart & Stroke has committed to action in improving women’s heart health, including:
• Requiring Heart & Stroke funded research to address sex and gender as appropriate, including clinical trial enrollment
• Creating focus and collaboration through establishing the Heart & Stroke Women’s Heart and Brain Health Research Network
• Engaging people with a passion for women’s heart and brain health, including women living with heart disease and stroke, to influence our research, programming and advocacy efforts