Why Is There So Little Female-Focused Research on Heart Disease?

Heart disease is the leading cause of death for women in America, accounting for more than one in five deaths. Still, far too few women realize the danger.

In fact, “Awareness of heart disease as the leading cause of death among women actually declined from 2009 to 2019,” Dr. Dipti Itchhaporia, president of the American College of Cardiology (ACC), said during a HealthDay Now interview. “We’ve done so many educational efforts over the past decade and still less than 50% of women recognize that heart disease is the number one killer.”

It’s also not widely known that women differ from men in the structure of their hearts, the types of heart problems they have, the risk factors for heart disease they carry, and even the symptoms they experience during a heart attack, experts say.

“I had a patient with jaw pain,” said HealthDay Now medical correspondent Dr. Robin Miller. “She went to the dentist twice before she came to see me, and she was in the midst of having a heart attack.”

Much of the problem stems from the fact that cardiology has long been a male-dominated field, said Itchhaporia, who is an interventional cardiologist with Hoag Heart and Vascular Institute in Newport Beach, Calif.

“I think women may not even think of cardiology,” Itchhaporia said of female doctors. “Women have different perceptions of cardiology than men, and they have different goals that could influence their choice.”

Female cardiologists are more likely to report sex discrimination, but it goes beyond that, Itchhaporia said. Women in medicine tend to choose fields that allow for long-term patient relationships, as well as a more family-oriented lifestyle.

Unfortunately, that lack of female perspective in cardiology has caused research into heart disease to be largely focused on men, Itchhaporia noted.

A study to be presented at the ACC’s upcoming meeting found that clinical trials led by a female doctor tended to have more women participating in them — 45%, compared with 38% when a man is in charge of the study, Itchhaporia said.

Not just smaller versions of male hearts

“Generalization of trial results may be inaccurate if the studies are only comprised of men. And so I think improving representation of women in trials yields more real-time, real-life results that reflect the broader patient population,” Itchhaporia said.

“The bottom line is preventing and treating heart disease requires a workforce that’s as diverse as the patients seeking the care,” she added.

So what are the differences between women and men when it comes to the heart?

“Let me just start by saying that up until about 20 years ago, we thought men and women’s hearts were the same. We were just men with periods,” said Miller, a practicing physician with Triune Integrative Medicine in Medford, Ore.

We’ve now learned that “women’s hearts are smaller, our walls are thinner, our blood vessels are smaller. We have a more rapid heart rate than men,” Miller said.

Women’s bodies also respond differently to stress, Miller said. Women experience an increase in heart rate, while men tend to have their blood vessels constrict, causing their hearts to pump harder and increasing their risk of high blood pressure.

Because of these physical differences, women tend to suffer different types of heart disease than men, the experts said.

“We don’t generally have the usual coronary artery disease. We have microvascular disease, which is in the smaller blood vessels,” Miller said. Because of this, the usual heart scans might miss impending disease in women.

Women are also more likely than men to experience a tear in a coronary artery, as well as a weakening of the heart’s main pumping chamber, known as “broken heart syndrome,” Itchhaporia and Miller said.

“Broken heart syndrome is like a stun gun to the heart where there’s a trauma and the heart looks like it’s having a heart attack, but it’s not,” Miller explained. “Generally, people recover. That’s far more likely to happen in women.”

You can watch the entire Healthday Now interview below:

Heart risk factors also differ

With these differences also come different risk factors for heart disease in women.

Some occur directly from specifically female medical conditions. For example, women can develop high blood pressure and diabetes during pregnancy, and those increase the risk of heart disease, Itchhaporia said.

“One of the newer things we found is that your menstrual history has an impact on your heart,” Miller added, noting that premature menopause, endometriosis and polycystic ovarian syndrome all increase heart risk in women. “Menopause is when things really start to go down. Once we stop having periods, our risk goes up.”

Even risk factors shared between the genders — cholesterol, high blood pressure, inactivity, obesity — can sometimes affect women differently than men.

“For example, women with diabetes are more likely to develop disease than men with diabetes,” Itchhaporia said. “Smoking among women is a greater risk factor for heart disease compared to men.”

Women even suffer different symptoms when they’re experiencing a heart attack, the experts said.

Studies have shown that some younger women, ages 30 to 55, who experience a heart attack had been experiencing symptoms for as long as a month, Miller noted.

“They just sort of ignore it,” Miller said. “They didn’t recognize the symptoms because sometimes they’re very vague.”

“You don’t have the classical chest pain,” Itchhaporia said. “Now they can, but they may have more neck pain, jaw pain, shortness of breath. So I think it’s just important for us to remember that atypical quality. There are some true sex differences.”

Because of these differences, Itchhaporia believes there “needs to be this redoubling of efforts by organizations interested in women’s health” to educate women on their gender-specific heart risks.

“Studies show that community-based programs — at churches, grocery stores, hair salons — are effective in improving awareness and ultimately outcomes,” Itchhaporia said. “And I really hope that social media will provide a really important tool to reaching the public about prevention and lifestyle management.”

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More information

The American College of Cardiology has more about women’s heart health.

SOURCES: Dipti Itchhaporia, MD, interventional cardiologist, Hoag Heart and Vascular Institute, Newport Beach, Calif.; Robin Miller, MD, practicing physician, Triune Integrative Medicine, Medford, Ore.