Unfortunately - and for reasons that aren’t entirely understood - women have not reached parity with men when it comes to complications and outcomes from heart disease treatment. Though research findings from studies conflict to some degree, the overall consensus has been that women are more likely than men to die within the first year after a heart attack - after which time the risk of mortality for both genders equalizes.
Proposed reasons for more deaths in women who have heart attacks compared with men have spanned a range of possibilities from bias to biology. Women may have been diagnosed later, treated less aggressively with surgery and interventional procedures, and less often been prescribed medication and referred to cardiac rehabilitation programs. This might be due to the fact that heart attack was falsely thought to be a condition unique to men.
Women sometimes delay in seeking treatment, thinking that they can’t possibly be having a heart attack. The myth that women are unlikely to have heart attacks has been fed by the fact that women’s heart attack symptoms are often less defined than men’s. While not all men have the classic chest pain or pain in the left arm or jaw, many do and see these symptoms as clear indication to seek help. Women may experience symptoms of nausea, fatigue, or back pain and not realize they are having a heart attack. Additionally, as these symptoms are common to many conditions, they can easily pose a diagnostic challenge to physicians.
What About Biology?
Do women have poorer outcomes from heart disease treatment because of biological differences between men and women? More research is necessary to definitively answer this question, but it seems likely that gender does play a role. After menopause, women are more likely to have heart attacks. So the “typical” female heart attack patient may be 10 to 15 years older than a male heart attack patient. Because women heart attack patients are often older, they may have more coexisting health problems.
Beyond heart attack deaths, women lag behind men in other key areas related to heart disease treatment:
- Surgical and interventional complications caused by bleeding
- Referral to and enrollment in cardiac rehabilitation programs, with lowest rates for low-income and African American women
- Treatment of stable angina (chest pain)
Closing the Gap
While, again, research studies have differed in their findings, serious attempts are being made to give women heart attack patients the same hopes for survival and quality of life as their male counterparts. For example, a study published in the American Journal of Medicine in 2008 detailed the results of implementing new cardiology guidelines from the European Society of Cardiology and the American College of Cardiology in hospitals in Israel. The result was a reduction in the number of deaths in women within one year after they were admitted to a hospital for acute coronary syndrome (a blockage in the blood supply to the heart muscle). This reduction in deaths brought their odds of survival in line with male patients.
Additionally, a greater effort is being made in the medical community to gather research related to women and cardiovascular disease. According to a consensus statement from Women in Innovations (WIN), a consortium of female interventional cardiologists from around the world, women have been under-represented in clinical trials and other studies, making it difficult for healthcare providers to determine the most successful treatments for them. Thankfully, that’s changing. Physicians, researchers, and others are working together to learn more about women and cardiovascular disease.
Men and women are different, and a greater awareness of those differences and the impact of factors that are unique to women will lead to more effective treatments and better outcomes for everyone.
For more information about women's and heart disease, visit the SecondsCount Women's Cardiovascular Health Center and visit WomenHeart.org.