Yet when I ask undergraduate students in my chronic disease class (most of whom are female) which disease causes the most deaths in women, only about half give the answer heart disease; a third say it is breast cancer.
So, why this dismal knowledge of heart disease in women?
Not just a “widowmaker”
One reason is that research has historically been conducted in middle-aged and older men. This is, in part, because men had heart attacks during their working years, potentially limiting their economic productivity.
Women — who tended to suffer heart disease at a later age — received less attention.
As a result, people both within and outside the medical profession had the impression that heart disease is for men.
This bias is easily recognized by the term “widowmaker” to describe the left main artery: One of the key arteries of the heart in which a blockage may lead to early death.
Smaller hearts and arteries
The second reason for our general lack of understanding of heart disease in women is due to differences in biology. We now know that the findings from research in men don’t fully apply to women — given differences in risk for heart disease and in anatomy.
As women get heart disease later in life than men, they also have more age-related risk factors than men — such as diabetes, which makes treatment more complex.
Smaller arteries also make diagnostic techniques like the electrocardiogram (ECG) and coronary angiography (X-ray imaging of heart arteries) more challenging.
Women have different symptoms
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One of the more perplexing facts about heart disease in women is that a heart attack can occur even without any heart arteries being blocked. This can happen with a “coronary artery spasm,” in which an artery of the heart suddenly closes upon itself. And it can happen with “spontaneous coronary artery dissection,” in which the inside of the heart artery tears, leading to a blood clot.
When there is no blockage, diagnosis by traditional methods is difficult.
While women having a heart attack can feel severe pain in their chest, many also experience more subtle symptoms such as shortness of breath, discomfort in their arms, neck and jaw, sweating or nausea.
Despite these symptoms being fairly common in women, they are still referred to as “atypical,” indirectly suggesting that a woman’s experience is not normal. Yet they are normal for women.
While there is much work to be done, each year this gap in knowledge and treatment closes in North America thanks in part to Health Canada and the US Food and Drug Administration implementing guidelines to ensure the inclusion of women in research.