Cardiac care: more good news for young, healthy white men

by Carolyn Thomas    ♥   @HeartSisters  

Being misdiagnosed with acid reflux and sent home from Emergency in mid-heart attack was when I learned that certain heart patients will be appropriately cared for, while other patients will not. I’ve been writing and speaking about what polite academics call under-served heart patient populations ever since since my own “widow maker” heart attack in 2008. And now a new international Commission has formed to “address the persistent disparities in cardiovascular health.” 

What the term “persistent disparities” specifically means is that the quality of care you’ll receive during your cardiac event varies depending on your age, your skin colour, your mental health and whether you’re a man or a woman.  

This is not new. We’ve known for decades that women with cardiac symptoms, for example, are significantly more likely than our male counterparts to be under-diagnosed – and worse! – under-treated even when appropriately diagnosed. (Just one small example, from one of many, many research studies confirming this implicit bias: “Fewer lights/sirens when a woman heart patient is in the ambulance“)

Cardiac researchers continue to churn out papers for publication that conclude what we already know about this shocking cardiology gender gap. Or, as my heart sister Laura Haywood-Cory (who survived a SCAD heart attack at age 40) likes to ask: “Do we really need yet another study that concludes:

“Sucks to be female. Better luck next life!?”    

Enter this new Commission, with some lofty goals to help address Laura’s constant query – and far beyond to reach other relevant factors behind disparities like old age, skin colour and mental health, too.  It’s called the Commission on Inequalities and Disparities in Cardiovascular Health led by The Lancet Regional Health–Europe. They explain their goals like this:

“Addressing the persistent disparities in cardiovascular health, this endeavour aims to serve as a catalyst for change. It seeks to usher in a new era of equity in cardiovascular health care and research, ensuring that progress benefits all sectors of society, especially those who have been historically under-served.”

This new Commission outlines why such a big project is important, including:

1. It would provide a vital platform for understanding the root causes of cardiovascular health disparities and identifying the specific needs and barriers faced by various groups, including the elderly, specific ethnic/racial groups, women, and individuals living with mental illness.

2. It would play a pivotal role in informing policy development aimed at reducing health inequalities. By pinpointing high-impact areas for intervention, policies can be tailored to ensure that funding and resources are directed towards those most in need and where they can have the greatest impact.

3. It would serve as a catalyst for collaborative efforts to address cardiovascular health disparities through advocacy and awareness-raising. This collaborative approach ensures that policy recommendations are rooted in scientific evidence while also incorporating practical aspects and the lived experiences of those most impacted by health disparities.

That last sentence is one I’m personally rooting for: “incorporating practical aspects and the lived experiences of those most impacted by health disparities.”  

“Those most impacted” means heart patients and our families – a demographic that until recently has rarely topped the average academic researcher’s wish list of credible resources.

The four groups the Commission will be focused on are selected for good reason. For example:

1. – “While women are generally perceived to have a lower risk of coronary heart disease mortality due to a lower disease prevalence, data from the past two decades reveal higher mortality rates among women, particularly following myocardial infarction (heart attack).”

2. – “Focusing on the elderly addresses the increasing prevalence of cardiovascular disease in aging populations and their specific needs for specialized care. Aging significantly increases cardiovascular disease risk, especially hospitalizations and deaths occurring in those over 65.”

3. – “By exploring the intersections of ethnic or racial identity, gender and social disadvantages, the Commission aims to identify and propose innovative solutions to narrow the health equity gap.”

4. – “Mental health conditions such as depression and anxiety can increase cardiovascular disease risk by influencing behavior, stress responses, and health practices. Recognizing stress as a shared risk factor for mental health and cardiovascular issues advocates for integrating stress management into preventive healthcare.”

It’s too early, of course, to predict the ultimate impact of this Commission and its stellar membership list.*  And it’s also hard for me to feel optimistic about another project launch by professionals who promise to change health care as we know it.

This one is especially fraught because the promised changes would realistically require changing our entire society as we know it. The field of cardiology is certainly not unique in experiencing implicit bias against those who are elderly, or mentally ill, or women, or non-white. This is no surprise to anybody who follows world news.

While I admire the visionary scope the Commission describes, I’ve often felt discouraged in the past by projects launched with, as my public relations colleagues would say, much sizzle – but ultimately not much steak. The American Heart Association’s last National Survey on women’s heart disease awareness was a perfect – and extremely disturbing – example.

Ironically, that survey tracked women’s awareness of heart disease after a full decade of public awareness-raising campaigns. Among other demoralizing findings, the survey’s results reported that women’s awareness of their most common heart attack risks and symptoms has actually significantly declined from the prior awareness survey done 10 years earlier.  The AHA’s special report in the cardiology journal Circulation revealed that in the 2009 national survey, 65 per cent of women surveyed were aware that heart disease was our leading cause of death.(2) But ten years later, awareness dropped to 44 per cent. Over half of the women surveyed could not name chest pain as a cardiac symptom. The 10-year awareness decline was observed in all races/ethnicities and ages – except women over 65 years of age. 

Results seemed somehow worse because the bearer of such news was the very organization that brings us the extensive and expensive Go Red For Women awareness campaign each February during Heart Month. As the American Heart Association’s own website boasts:

“Now in more than 50 countries, Go Red For Women is a global phenomenon of fashion shows, luncheons and campaigns that help women improve their health and the health of their families.”

Or do they?  I suspect that they’re mostly preaching to the already-informed choir. Despite all the Go Red fashion shows and luncheons, those 10 years between national surveys turned out to be, as the AHA executives themselves admitted, “a decade of lost ground“. 

In her compelling essay two months ago called Heart Month: Redesigning the Message,(3) cardiologist and Commission co-chair Dr. Martha Gulati asks her colleagues if it’s finally time to revisit and revise Go Red for Women. (I had also asked a similar question here when I wrote “Women’s heart disease: is it time to hang up the Red Dress?“)

Dr. Martha shared this important reminder:

“Heart disease remains the leading killer of women, but lack of awareness remains a close second. We need to change this, in order to save the hearts of women.”

But HOW to change?  Ah, there’s the rub. Lighting up tall downtown buildings with red floodlights and wearing little red dress lapel pins during Heart Month does NOT raise anybody’s awareness of women’s heart disease –  or affect the implicit bias that the Commission vows to eliminate.

I worry that their stated goals seem impossibly broad, much like the U.N.’s  Global Goals (also known as Sustainable Development Goals). In 2012, the U.N. announced: “Here are the world’s biggest problems, and here is how we’re going to measure progress on them.”  This project includes goals of ending extreme poverty and hunger, fixing climate change and education, and reducing  inequality and corruption. But as Bill Gates writes in his blog, Gates Notes:

“Global Goals are too much of a good thing. We’re halfway to the achievement goal of 2030, but only 15 per cent are on track. Having so many targets wouldn’t necessarily be an issue if the world were stepping up to fund all of them. But it’s not.”

I have no doubt that the members of this new cardiovascular health  Commission have their hearts in the right place. They want to do something to help create a seismic change in improving what’s clearly not working in cardiology – but what? And how? And who will pay for it? And how will they make their findings public? And how many actionable steps will be realistically evaluated?

Or will the efforts of this new group end up as another disheartening special report published in yet another cardiology journal 10 years from now?

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Q:   What do you make of this Commission on Inequalities and Disparities in Cardiovascular Health?

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NOTE FROM CAROLYN:  I wrote much more about inequalities and disparities in cardiovascular health in my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press).  You can ask for it at bookstores (please support your local independent bookseller) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price). 

Disclaimer:  Dr. Martha Gulati, Commission co-chair, wrote the beautiful foreword to my book.

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1. Raffaele Bugiardini et al. “Commission on Inequalities and Disparities in Cardiovascular Health by The Lancet Regional Health–Europe”. The Lancet Regional Health-Europe. Volume 41. June 2024.

2. Cushman M, et al. American Heart Association. “Ten-Year Differences in Women’s Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association.” Circulation. 2021 Feb 16;143(7):e239-e248.

3. Gulati M. “Heart month: Redesigning the Message.” American Journal of  Preventive Cardiology. 2024 Feb 28;17:100643.

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* Commission members include:

• Bugiardini, Raffaele (Italy)
• Gale, Chris P (UK)
• Gulati, Martha (USA)
• Anand, Sonia (Canada)
• Maas, Angela HEM (Netherlands)
• Townsend, Nick (Belgium & UK)
• Vaccarino, Viola (USA)
• Badimon, Lina (Spain)
• Cenko, Edina (Italy)
• Manfrini, Olivia (Italy)
• Jha, Pooja (Germany