Gender still plays too great a role in heart health

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Adjunct Professor John Kelly, AM

CEO-National, Heart Foundation
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John joined the Heart Foundation in August 2016. Previous to that, he led sector reform for aged care as CEO of Aged and Community Services Australia. He has extensive clinical, management and consulting background in the health sector, including previous careers in law and in cardiac nursing and current academic appointments with the Sydney Nursing School and the University of Technology, Sydney.

International Women’s Day is a day to celebrate women’s achievements, with this year’s theme being “Press for Progress”. So this is also a time to focus on solving problems that especially affect women – such as the fact that heart disease in women remains under-recognised, under-treated and under-researched.

To begin, most women don’t even realise the extent to which they are vulnerable to heart disease. Our latest figures tell us that only 34 per cent of women know that heart disease is a major cause of death in women.

Meanwhile, the dangerous stereotype persists that heart disease is solely a men’s problem, making women aged 30-65 less likely than men to speak to their GP about heart disease or to have a heart health check.

It doesn’t help that the symptoms of heart attack in women may be different from the classic “chest pain” that is commonly seen on TV. Whilst some women may experience chest pain, not all will. Women need to know that the onset of a heart attack can also be signalled by pain in the jaw, back or neck, shortness of breath, nausea, vomiting and cold sweats, overwhelming fatigue or anxiety, lethargy and loss of appetite.

Another problem is that women’s personal priority is so often to look after other family members rather than themselves. A 2014 Heart Foundation survey of 504 heart attack survivors showed that women were slower than men to seek help about worrying symptoms, and more likely to tell a friend or family member than to call 000.

Women’s heart troubles sometimes continue when they do get to hospital. Both local as well as US and Swedish studies have shown they are more likely to face delays in treatment and to be classified as in need of less urgent help.

Research by Associate Professor Lisa Kuhn from Melbourne’s Monash University showed that women waited almost double the recommended 10 minutes after arriving in emergency before having their first electrocardiogram and were less likely than men to be sent to the specialist coronary care unit. Women are also less likely to undergo specialist procedures such as angiograms, bypasses and stents.

Increasing recognition that gender plays a part in heart disease has led to new questions being asked, and new actions being taken.

Traditionally, women have been under-represented in heart disease research, with research most frequently conducted on middle-aged and older men. This means that many treatments have been tested on men and the findings extrapolated to women. As Dr Kuhn points out, “Women are not simply smaller versions of men. They have blood vessels that behave differently when a coronary event is occurring. The role of hormones and other factors come into play.”

This suggests we can no longer just assume that heart disease in women and men is the same.

Accordingly, more research into women and heart disease is urgently required. The Heart Foundation is focusing on the issue more intently than in the past. Since 2015, the Foundation’s NSW Women and Heart Disease program has funded two research studies into heart disease in women to the value of $300,000. Nationally, women now make up around 50 per cent of the researchers funded by the Heart Foundation.

Over the next few years, we shall make it a priority to further address the imbalance in research topics and commission extensive new studies into women’s heart health.

We are working towards an International Women’s Day where articles like this one would have no place.