It’s well-known that women are less likely to be diagnosed with heart disease than men, even when they have identical symptoms, such as chest pain. Women who have the disease are also less likely to receive aggressive treatment. Numerous studies have confirmed these facts.
But the reasons, until recently, were a good deal less clear. In days gone by, historical stereotypes played a part.
Women were viewed as weaker, more ready to complain than men. That might have led caregivers to dismiss symptoms of genuine illness.
In addition, it was once thought, before reliable statistics were kept, that men had a higher risk of heart disease. That might have explained why they got more aggressive treatment.
But neither of these beliefs is correct. Women do not over-report their symptoms, and they are just as likely as men to have the disease.
Moreover, we’ve known this for at least two decades. Yet a higher percentage of women continues to be under-diagnosed, and to pay for it with their lives.
How can that be? Is the medical profession really still mired in 19th-century views about gender?
Until recently, and improbable as it seemed, that appeared the only viable explanation. However, glimmerings of a different understanding are beginning to emerge.
It appears women’s cardiovascular systems might be different than men’s, and that can lead diagnostic tests to give false readings.
Dr. Karin Humphries at the University of B.C. has shown that women who have normal angiograms — an X-ray procedure that looks inside coronary arteries — are four times more likely than men to be hospitalized subsequently for ongoing chest pain.
The reason is that coronary artery disease in women often doesn’t show up on a standard angiogram, even although it is present. As a result, the patient is told she is healthy, when she is not.
Another test looks for certain markers in blood. If a patient has an abnormally high reading, that’s evidence of heart disease.
But here also, it’s possible the sexes differ. Women are twice as likely as men to have a normal score, when, in fact, the situation is anything but normal.
It appears women’s hearts, whether healthy or not, produce less of the chemical that sounds an alarm. That produces the mistaken impression. The patient is told she is fine, when a heart attack has already occurred.
So what are we doing with this knowledge? Some important first steps have been taken.
A women’s heart clinic has been set up in Vancouver — the first of its kind in B.C. Dr. Tara Sedlak, who runs the clinic, has pioneered new diagnostic tests that give more reliable readings.
But nothing comes easily when you swim against the tide. Money, as ever, is a problem. Some of the new tests are expensive — $1,000 or more — and the Health Ministry hasn’t agreed yet to cover all of the costs.
And both Humphries and Sedlak are disputing a long-held belief — that standard angiograms are an entirely reliable indicator of heart health.
In one sense, resistance is understandable. Extraordinary claims need extraordinary evidence. When you question a well-established procedure, you need a formidable body of proof on your side.
But increasingly, the evidence seems to support this revolutionary new approach. Research in other countries backs up what Humphries and Sedlak are saying.
At a minimum, women’s heart clinics should be set up in other major centres to carry on this critical work. Victoria, with the province’s top-rated cardiac centre at Royal Jubilee, is an obvious choice.
Each year, about 3,500 women die of heart disease in B.C. We can, and should, do better.
