As a cardiologist, I thought I would be the first person to recognise cardiovascular disease in myself, but I was wrong. When I was pregnant, not only did I fail to recognise the signs of severe hypertension (very high blood pressure) but so did my midwife and obstetrician. In retrospect, the effects of hypertension were present for several weeks but somehow we managed to find a rational explanation for my symptoms that did not involve a diagnosis of cardiovascular disease. It was only when my life and that of my unborn son was at risk that the correct diagnosis was made.
Every year, twice as many women die from cardiovascular disease in the UK as from breast cancer. This translates to three women dying every hour from a heart attack. This statistic may surprise many people, including health care professionals – and perhaps reflects the fact that some diseases, such as cancer, are more emotive and attract greater publicity and research.
Chris Gale, professor of cardiovascular medicine at the University of Leeds, has researched the investigation, treatment and outcomes of cardiovascular disease in several countries including the UK. He has discovered huge deficiencies in the care provided for women compared with men. These gender disparities, combined with the fact that women have a higher burden of non-cardiac illnesses, lead to poorer outcomes for them.
The staggeringly high death rate from cardiovascular disease in women reflects a worrying trend: women are less likely than men to recognise that they have symptoms related to heart disease, so they seek help later than men, their symptoms are more likely to be misinterpreted by health care professionals and up to 50 per cent of women with heart attacks are initially misdiagnosed.
Women have less chance of being investigated adequately: one study found that paramedics are less likely to perform a heart tracing to rule out a heart attack in women than they do in men. Another study found that the “door-to-balloon time” – the crucial time taken between the arrival in hospital of a patient having a heart attack to the opening up of the blocked coronary artery – is longer in women than in men. Even if women receive the correct diagnosis of heart disease, they are less likely to have the appropriate treatment.
Women present later, are under-investigated, under-treated and have poorer outcomes from all forms of cardiovascular disease when compared to men. Moreover, the prevention and treatment of cardiovascular disease has historically focused on men’s health. Typically, women are woefully under-represented in clinical trials that test treatments. The majority of new drugs are tested on Caucasian men and then rolled out to everybody. For example, the early cholesterol-lowering (statin) drug trials had few or no women recruited in the studies and yet statins were prescribed for everyone.
Certain cardiovascular risk factors such as diabetes and smoking confer a greater detrimental effect on women than they do on men but there is limited awareness of this increased risk among the public and health care professionals. While most women tend to have the same “typical” symptoms of a heart attack as men, a significant proportion do not – and unless the differential diagnosis of heart disease is considered, this often gets missed.
Women’s cardiovascular health has been neglected despite it being the biggest killer of women worldwide. Heart Foundations around the world are trying to raise the profile of cardiovascular disease in women, with the hope that with the same level of publicity, awareness, funding and research as other, more emotive diseases, women will gain parity with men in cardiovascular health.
Until then, there will be more women, like me, who never realise they have heart disease and for many, the diagnosis will be made too late.
Nishat Siddiqi is a cardiologist based in South Wales
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This article appears in the 06 Feb 2019 issue of the New Statesman, Broken Europe