Time’s Up for Heart Disease in Women

What doesn’t kill you, makes you stronger, right? What if it doesn’t? What if negative life events and social stress damage women’s long term physical health? We know the social inequities, harassment, and discrimination that women deal with in education, business, the workplace, even at home, but also make room in the gender gap for heart health – an area that research shows can be impacted by the social pressures women face.

Heart disease is the #1 killer of women worldwide. When American women were asked about their biggest health risk, only 65% of white women recognized heart disease as the leading cause of death in women, with even lower recognition in black and Hispanic women. Also, while heart disease is typically considered a disease of older men, data shows that rates of heart disease deaths in younger women 35 to 44 years old continue to increase, while decreasing in men the same age.

Thinking that is too far away in life to worry about now? Consider the fact that the health choices and behaviors we have in our 20s and 30s -  smoking, weight, physical activity, diet - set the stage for our health as we age. In addition, research is beginning to show that particularly for women social stress, trauma, and negative life experiences may impact long-term heart health. So, while heart disease may not be on your radar now it is something women need to think about at all ages and in all stages of our complex and crazy lives.

Gender differences in the causes of heart attack

Psychological factors play a much more important role as a cause of heart attack in women where as heavy exercise is a more common cause in men. Stress is frequently thought to be associated with heart attack – for women, the normal demands of a busy life are not the issue, but more concerning is psychological stress endured at home or at work. Depression and enduring hostility have much greater heart health impact on women than men.

A recent study showed that women who experienced a traumatic event anytime in life (death of a child, being victim of serious physical attack/assault, life-threatening illness or accident to spouse/child) or several negative events (e.g. death of someone close, being unemployed for 3+ months, robbed or burglarized) in recent years have higher odds of being obese than women who without such stress. This relationship of trauma and obesity remained even for those women who exercised regularly. Other studies have also shown that despite efforts to eat right and exercise, loneliness, lack of positive social relationships, or having a negative outlook on life increases risk of heart attack in women.

Social stigmas and seeking or receiving care

Despite all that is known about gender differences and health, medicine does not do a great job of taking gender into account in diagnosis, treatment or disease management. Also, women tend to delay seeking medical care longer than men. 81% of women responded to a survey that they would call 9-1-1 if they thought someone was having a heart attack. However, only 65% would call 9-1-1 if they thought they were having a heart attack.

Women with heart attack symptoms reported trouble getting diagnosed, perception they were not taken seriously by healthcare providers, and were often simply treated for depression or indigestion. Delays in treatment and diagnosis left women understandably frustrated and angry. There are various opinions on why women have trouble getting diagnosed for heart attack – not knowing or incorrectly communicating symptoms or the fact that women experience different and perhaps more confusing symptoms than men. To make things worse, women with heart attack tend to receive less aggressive treatment for heart attack than men, which can result in slower or worse recovery.

The gender gap in healthcare exists even outside the doctor’s office. A recent study found that men in cardiac arrest are more likely to receive bystander CPR in public compared to women, which gives men 23% increased odds of survival compared to women. CPR involves pushing on the chest, which some think given the current climate of sexual harassment could make people less certain whether they can or should do CPR in public on women.

Luckily there are some solutions that we can take on for ourselves. 

Be the boss of your health

·       Know your personal risks and be proactive to manage them. You are never too young to prevent heart disease.

·       Know the symptoms for heart attack in women. Although almost half of women consider themselves well informed about heart disease, many have difficulty identifying symptoms of heart attack.

·       Don’t delay getting help – call emergency medical services if you think you or someone else is having a heart attack.

·       Educate yourself - most women likely do not know that they are receiving sub-par care. If you do have to seek medical care for yourself or a loved one make sure you understand the healthcare provider’s recommendations or care plan. Don’t be afraid to ask questions.

·       Learn CPR – the more women who know CPR, the more women will receive it if needed.

Put your mind over your matter

·       Don’t suffer in silence - be they in person or online, finding positive social relationships that provide interaction and create a sense personal worth can decrease the impact that depression, trauma, and social stress can have on our hearts.

·       Take time for yourself - so many women take care of everyone else first and leave little to no time or energy for themselves. Remember that taking care of yourself is necessary for you to be able to care for others.

·       Find your happy place – happiness is described as joy, excitement and contentment combined with meaning and purpose. Happiness is not about an absence of stress or pain, but acknowledging that there are hard times yet living authentically and for a greater good. Find what gives you purpose and joy and build it into every day.

·       Create a positive outlook - despite what we see on the news, there are great things that happen in the world every day. Seek out the beauty and good in life and you will become it.

Melanie Turner is a public health professional with specific interests in global health and risk prevention in women and underserved populations. She has published several papers related to heart disease and stroke statistics, strategies and progress towards AHA and WHO goals, community and population cardiovascular health.

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References:

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Blewer AL et al. Gender Disparities Among Patients Receiving Bystander Cardiopulmonary Resuscitation in the United States. Circulation. 2017;136:A16409.

Daviglus ML et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA. 2004 Oct 6;292(13):1588-92.

Matsushita F et al. Cumulative Negative Traumatic Life Events and Obesity in Women. Circulation. 2017;136:A20492.

McSweeney JC et al. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement from the American Heart Association. Circulation. 2016 Mar 29;133(13):1302-31.

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Science Alert. This Is The Biggest Key to Happiness, According to Science. Available at:  http://www.sciencealert.com/experiencing-adversity-true-happiness-eudaimonic-hedonistic. Accessed January 14, 2018.


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