Features

Heart attack gender gap

18 March 2022

Heart disease is the single biggest killer of women, so why is it still labelled a ‘man’s disease’? Helen Wilson from Heart Research UK on raising awareness and encouraging women to look after their heart health.

It’s a common misperception that heart disease is a ‘man’s disease’ and doesn’t affect women. In fact, coronary heart disease (CHD) kills more than twice as many women as breast cancer in the UK every year (British Heart Foundation (BHF), 2019a). It is also the single biggest killer of women worldwide (World Economic Forum, 2021). In the UK, 830,000 women are currently living with CHD and 35,000 women are admitted to hospital following a heart attack each year – an average of 96 women a day, or four every hour (BHF, 2019a).

At Heart Research UK, we want to challenge the misperception of heart disease as a ‘man’s disease’ and encourage women of all ages to take action to look after their heart health, and to understand the risks and recognise the symptoms of a heart attack. As community practitioners (CPs), you can play a major role in this.

Needless deaths

A survey by Heart Research UK, produced in conjunction with Damart, questioned over 4000 women about their understanding of their heart health and found that:

  • A third (33%) of women have never had their blood cholesterol level checked
  • Nearly half (48%) have never had their blood pressure checked or not had it checked in the last six months
  • More than half of the women questioned (58%) were unaware that their risk of CHD increases after the menopause (Heart Research UK, 2017).

These startling statistics underline women’s limited awareness of their own risk of developing CHD, and lack of knowledge of the importance of medical and lifestyle risk factors.

CHD is usually the cause of heart attack. Contrary to popular belief, research conducted at the University of Edinburgh (Ferry et al, 2019) has found no difference in key heart attack symptoms between men and women. Chest pain was found to be the most common symptom in type 1 myocardial infarction, with 93% of both sexes reporting this. Similarly, both men and women reported pain that radiated to their left arm (48.4% and 48.9% respectively).

The conclusion of the research was that incorrectly assuming that women having a heart attack suffer different symptoms from men could lead to misdiagnosis, delayed treatment and less intensive medical interventions.

But women having a heart attack tend to delay getting medical help longer than men because they are less likely to recognise the symptoms, which in turn reduces their chances of survival (BHF, 2019b).

Notably, women are not taking part in clinical trials to the same extent as men and have therefore been under-represented in clinical research (BHF, 2019b). Consequently, the development of diagnostic techniques and treatments for cardiovascular disease have been based on research conducted primarily on men.

Wu et al (2018) has shown that women have a 50% higher chance of receiving the wrong initial diagnosis after a heart attack, and so are less likely than men to promptly receive the life-saving treatments they need. In addition, research has found that women were about half as likely as men to receive recommended heart attack treatments (Lee et al, 2019). This means that women with CHD are dying unnecessarily from heart attacks and have worse outcomes than men because they do not receive the same care and treatment.

The resulting differences in care for women have been estimated to have contributed to over 8243 avoidable deaths in England and Wales over a decade (BHF, 2018).

Our CEO, Kate Bratt-Farrar, says, ‘In light of these numbers, we are really urging women to take action to understand the risk factors for CHD, such as high blood pressure, high cholesterol levels, a family history of CHD, smoking, obesity and diabetes.

‘After menopause, these factors may be more likely to lead to CHD in women. We need your help to remove the gender inequalities in heart attack diagnosis and treatment, and work to prevent these avoidable deaths.’

It has been found that pre-menopause, women in general have a lower risk of developing CHD than men. It is thought that oestrogen, a naturally produced hormone, helps to control cholesterol levels and reduces the risk of fatty plaques building up inside artery walls. Therefore, oestrogen may provide some protection against CHD, resulting in pre-menopausal women being less likely to develop the condition than men (Mehta et al, 2016).

‘We need your help to remove the gender inequalities in heart attack diagnosis and treatment’

However, the onset of menopause can have a significant effect on a woman’s susceptibility to CHD due to declining levels of oestrogen (Mehta et al, 2016).

What can you do?

We’ve now established that women need to become aware of their risk of developing CHD and have a better knowledge of the importance of both medical and lifestyle risk factors. These are all areas where CPs can have a significant impact on their communities, to support, raise awareness and advise women.

Encouraging women to take advantage of the NHS Health Check is a great way to start. According to the NHS, during its first five years, this programme is estimated to have prevented 2500 heart attacks or strokes (NHS, 2019).

Lifestyle factors that impact negatively on heart health include poor diet, being overweight, low physical activity levels, smoking and excessive alcohol intake. As a CP, talking to women about their current lifestyle habits and helping them to identify where changes can be made to improve their heart health is a good start. Discussing the barriers to behaviour change, such as a lack of time or money, and helping women to find solutions that suit them, without being judgemental about their lifestyle choices, can be empowering and motivating. CPs should be aware of up-to-date resources available to support women in making and maintaining healthy lifestyle changes. For example, the NHS Better Health website supports people to lose weight, get active, stop smoking and reduce their alcohol intake.

Helen Wilson is head of research at Heart Research  UK and has worked for the charity since 2008.  She is responsible for the strategic planning of the charity’s research activities and management of the research portfolio, ensuring that Heart Research UK supports high-quality projects.


Resources


Time to reflect

How can you encourage women to improve their heart health? Are your clients aware of the risk factors for CHD? Join the conversation on Twitter using #WomensHeartHealth via @heartresearchUK @CommPrac


British Heart Foundation. (2019a) Heart attack gender gap is costing women's lives. See: bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/september/heart-attack-gender-gap-is-costing-womens-lives (accessed 16 February 2022).

British Heart Foundation. (2019b) Bias and biology: How the gender gap in heart disease is costing women’s lives. See: bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease/download-bias-and-biology-briefing (accessed 16 February 2022).

British Heart Foundation. (2018) 8000 UK women die due to unequal heart attack care. See: bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2018/november/8000-uk-women-die-due-to-unequal-heart-attack-care (accessed 8th February 2022). 

Ferry AV, Anand A, Strachan FE et al. (2019) Presenting symptoms in men and women diagnosed with myocardial infarction using sex-specific criteria. Journal of the American Heart Association 8(17): e012307. See: https://pubmed.ncbi.nlm.nih.gov/31431112 (accessed 16 February 2022).

Heart Research UK. (2017) Women’s health campaign. See: https://heartresearch.org.uk/wp-content/uploads/2021/08/Heart-Research-UK-and-Damart-LovingHearts-Survey-report.pdf (accessed 3 March 2022).

Lee KK, Ferry AV, Anand A et al. (2019) Sex-specific thresholds of high-sensitivity troponin in patients with suspected acute coronary syndrome. Journal of the American College of Cardiology 74(16): 2032-43.

NHS. (2019) What is an NHS Health Check? See: nhs.uk/conditions/nhs-health-check/what-is-an-nhs-health-check-new (accessed 16 February 2022).

World Economic Forum. (2021) Heart disease is the leading cause of death in women – here’s how we can address it. See: weforum.org/agenda/2021/06/heart-disease-is-the-leading-cause-of-death-in-women-worldwide-lancet-commission-cvd-stroke (accessed 16 February 2022)

Wu J, Gale CP, Hall M et al. (2018) Editor’s choice – impact of initial hospital diagnosis on mortality for acute myocardial infarction: a national cohort study. European Heart Journal. Acute Cardiovascular Care 7(2): 139-48.

Image credit | Shutterstock

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