Heart disease is the main killer worldwide. It kills more women than men as they are often underdiagnosed, undertreated, and suffer more adverse effects to treatments.
Every March 8th the International Women’s Day celebrates women and their achievements, reminding everyone to call for gender parity. Healthcare is one of the major issues impacting women worldwide. It is paramount to account for sex differences in healthcare since men and women’s biology and physiology are not equivalent, resulting in distinct risk, presentation, diagnosis, treatment and outcome of diseases.
Cardiovascular disease is the top cause of death around the globe for both men and women but women deaths exceed men’s. In the European Union, 34% of men compared to 40% of women die from heart disease. Still, women are often underdiagnosed and undertreated compared to men.
Women at risk
While progress has been made, there is a serious blind spot to biological sex differences in healthcare that do not concern only reproductive health. The risk of heart disease in women is still often underestimated by both the medical community and by women themselves. Women are less likely than men to get tested for heart-related illnesses and are less likely to receive surgery.
The idea that heart disease is a “man’s disease” is deeply rooted. This notion started to change in the mid 20th century and only in the last few decades has awareness been rising on how it affects each sex distinctly. However, the lay population remains oblivious to this fact and healthcare worldwide frequently neglects sex differences.
Why sex matters
Biological differences between men and women are real and impact the course and severity of many heart diseases, as well as the side-effects of treatments. Indeed, the male and female cardiovascular systems are anatomically and physiologically unlike in many aspects. Hence, it is no surprise that the symptoms of heart diseases also differ.
For example, the typical male heart attack symptoms include chest, neck or back pain, discomfort in one or both arms, and shortness of breath. Although women can also experience chest pain, many do not and the most common symptoms are shortness of breath, fatigue, nausea or vomiting, and cold sweat. Since women’s symptoms may not always accompany chest pain, it is often harder to correctly diagnose a heart attack. Consequently, they are less likely to receive the recommended treatments, worsening disease outcome and increasing mortality rates.
Inequality in medical research and clinical trials
One of the main reasons women fare worse is that they are underrepresented in research studies and clinical trials, as it is assumed that what works for one sex works for the other. Despite many pieces of evidence to the contrary, the discovery and development of diagnostic tools and drug treatments are still done mostly with data from men or male animals.
Diagnostic and prognostic markers of heart disease can be sex-specific. For instance, the most important biomarker of heart attack in the blood, cardiac troponin, is less secreted in women, often leading to misdiagnosis and subsequent poorer outcome. Treatment is usually the same for both sexes but it may not be as efficient in women as in men and, since the dosage may not be adjusted for women’s physiology, they are likely to suffer more side effects. Such scant sex-specific research gives doctors little guidance on how to best interpret diagnostic markers and to prescribe treatments for women.
Bridging the gap
It is crucial to increase awareness to this major issue among the general population, women and men alike. Moreover, the medical and research communities must routinely address sex-specific differences to improve women’s health by developing appropriate diagnostic strategies and therapeutic approaches.
Important discoveries may arise by including both sexes in studies and everyone benefits. Such concerted actions are essential to reduce heart disease in women and to develop personalized medicine, with more effective treatments for all.
- Alabas et al. Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry. J Am Heart Assoc. 14;6(12), 2017.
- Lichtman et al. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation. 137(8):781-790, 2018.
- McSweeney et al. Women's early warning symptoms of acute myocardial infarction. Circulation. 108(21):2619-23, 2003.
- Wenger. Perspective: A heartfelt plea. Nature. 550(7674):S9, 2017.
Author: Clarissa Pedrosa da Costa Gomes