How doctors discovered that women have heart attacks, too

by Carolyn Thomas   ♥  @HeartSisters

Following my heart attack, my family doctor told me that when she was in medical school, the type of heart attack that I’d had was called a ‘widowmaker‘.

This was apparently because a full blockage like mine in this particular coronary artery was usually fatal, thus making the patient’s wife an instant widow. Please note the gender imbalance: men – the ones who could ‘make’ a ‘widow’  – were considered to be the ones suffering this kind of heart attack. Doctors don’t, for example, call it the widower maker . . .

Alas, there are still doctors who are unaware that, since 1984, more women than men die of heart disease each year.  An American Heart Association survey found that only 8% of physicians (and an even more appalling 17% of cardiologists!) actually knew that heart disease kills more women than men annually.

So I was intrigued to run across this chronological overview on Gender and Cardiovascular Disease showing how since 1970, the medical profession has gradually – and I do mean gradually – wisened up to the reality that heart disease is a woman’s disease, too. 

Until the past decade, most cardiac research has mainly focused on (white, middle-aged) men’s cardiac risk factors, symptoms, and treatment of cardiovascular disease. Most tests for diagnosing heart disease have been fine-tuned in studies focused on men.

Even the lab mice used in early studies were male animals.

The treadmill stress test, for example, has been found to be far less accurate in women than in men, and particularly for identifying single vessel or non-obstructive heart disease – which are both more common in women.

The ‘gold standard’ test for diagnosing coronary artery disease in both men and women is the angiogram, but studies also show that women are less likely than men to be referred for angiography. And some types of non-obstructive heart disease like coronary microvascular disease or  Prinzmetal’s angina do not show up during routine angiography (unless the coronary artery spasm happens to actually occur during the procedure).

For more mind-boggling data on the existing gender gap in cardiology prevention, diagnostics and treatment, read more about a comprehensive report published in the journal, Mayo Clinic Proceedings in: Does your hospital have a Women’s Heart Clinic yet? If not, why not?

But here’s how this gender gap slowly began to be addressed:

• 1970:   Women’s experience and tolerance of cardiac surgery began to appear in medical literature ^[1]

• 1980:   Increased focus on various health issues concerning women (abuse, breast cancer, menopause, cardiovascular health)^[2]

• 1995:   A chapter on cardiovascular disease in women was written for the Heart and Stroke Foundation of Canada^[3]

• 1999:   The American Heart Association presented a report on the primary prevention of cardiac disease in women in the United States^[4].

• 2004:  The American Heart Association provided recommendations on cardiovascular disease risk factor management for women.^[5]  

• 2016:  The American Heart Association, 92 years after it was established, finally issued its first ever scientific statement on women’s heart attacks.[6] 

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References:

• 1. King. K.M., Paul P. (1996) A Historical Review of the Depiction of Women in Cardiovascular Literature. Western Journal of Nursing Research, 18(1): 89-101.

• 2.  Allen, D., Allman, K.K.M., and Powers, P., (1991) Feminist Nursing Research Without Gender. Advances in Nursing Science, 13 (3): 49-58.

• 3.  Heart and Stroke Foundation of Canada: Heart disease and stroke in Canada. Ottawa, Canada, 1995.

• 4.  Mosca, L. Grundy, S.M., Judelson, D., (1999) Guide to Preventive Cardiology for Women. Circulation. 99:2480-2484.

• 5.  Mosca et al. American Heart Association Scientific Statement. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. Circulation. 2004;109:672-693.

• 6.  Laxmi S. Mehta et al. Acute Myocardial Infarction in Women. A Scientific Statement From the American Heart Association.  Published online before print January 25, 2016, doi: 10.1161/CIR.000000000000035.

See also:

 

How these doctors have saved thousands of women

The sad reality of women’s heart disease hits home

Women under age 55 fare worse after heart attack than men

Researchers openly mock the ‘myth’ of women’s unique heart attack symptoms

Cardiac gender bias: we need less TALK and more WALK

Women’s cardiac care: is it gender difference – or gender bias?

Unconscious bias: why women don’t get the same care men do

How can we get female heart patients past the E.R. gatekeepers?

Heart disease – not just a man’s disease anymore

When your doctor mislabels you as an “anxious female”

Why are women with atrial fibrillation treated differently?

Women missing the beat: are doctors ignoring women’s cardiac symptoms?

Yentl Syndrome: cardiology’s gender gap is alive and well

The breast/uterine cancer study with no women invited 

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