Heart disease: more evidence that advice on preventing it comes down to gender

If you were to ask your doctor about how to best go about avoiding heart disease, the advice you receive may very well depend on whether you are a man or a woman.

And as an Australian expert says, this is more than another gender problem in health care, because often women don’t know what symptoms to look for and describe.

New research in the US has reinforced the problem of diagnosis and treatment when women present with heart issues. “This is despite the fact that guideline recommendations to prevent heart disease are the same for men and women,” says Dr. Prima Wulandari of Harvard Medical School and Massachusetts General Hospital, Boston, US.

With previous studies already demonstrating sex differences when it comes to treating cardiovascular disease (women tend to be given less aggressive treatments than men), Wulandari set out to investigate if and in what ways sex impacts prescribed preventative measures.

Heart disease prevention for women is typically diet- and exercise-based.
Women are typically told to lose weight, reduce their intake of salt and calories and do more exercise to prevent disease. Credit: Chinnapong/Getty Images

Wulandari’s results are a both somewhat shocking and unsurprising.

Eat better, lose weight and exercise more to prevent heart disease – unless you’re a man

“Our study found that women are advised to lose weight, exercise and improve their diet to avoid cardiovascular disease but men are prescribed lipid lowering medication,” she said.

In fact, in an analysis of 2,924 participants from the US National Health and Nutrition Examination Survey in 2017 to 2020, identified as at increased risk of developing cardiovascular disease, men were 20% more likely to be prescribed statins than women. On the other hand, women were 27% more likely to be advised to lose weight, 38% more likely to be told to exercise, 27% more likely to be instructed to reduce their salt intake and 11% more likely to be told to reduce their fat or calorie consumption.

None of these recommendations are bad or misleading. A healthy diet and exercise, along with limiting salt and carrying less weight are all key parts of the European Society of Cardiology’s guidelines for preventing cardiovascular disease, with statins recommended based on a patient’s individual characteristics (such as age and risk of developing heart disease).

Read more: Women disadvantaged when it comes to cardiac care

Differential diagnosis and treatment based on gender is not new. Women are less likely to be believed when it comes to pain and less likely to be diagnosed correctly when having a stroke.

Heart disease can present differently

Dr hannah brown
Dr Hannah Brown is a research operations specialist at the Victorian Heart Institute. Credit: Dr. Hannah Brown

“There are also real differences in the perception of heart disease risk in women and men,” says Dr Hannah Brown Strategy, Innovation and Operations Manager at the Victorian Heart Institute (soon to be the Victorian Heart Hospital). “People think heart disease is uncommon in women, but it kills more than two times as many women as breast cancer – although it’s absolutely not a competition!” she adds.

It doesn’t help that the symptoms of a heart attack aren’t necessarily the same for women as they are for men.

“Although still the most common symptom, women don’t necessarily get the crushing chest pain but tend to experience other symptoms, such as nausea, sweating and back pain,” says Brown.

Read more: Have a heart: is there a funding shortfall for cardiovascular research in Australia?

“But we haven’t done a great PR job of telling people it might be different. And as a result, it’s not clear that women know what symptoms to look for. There’s also good evidence that they prioritise the care of their families over their own health, hence presenting with worse disease.”

Check in on your heart health with your gp
Check in on your heart health with your GP. Credit: PeopleImages/Getty Images

Wulandari looked to existing literature for possible reasons to explain the study results. The literature review “demonstrated that a potential root of the discrepancy in advice is the misconception that women have a lower risk of cardiovascular disease than men”, she says.

“Our findings highlight the need for greater awareness among health professionals to ensure that both women and men receive the most up-to-date information on how to maintain heart health.”

In the meantime if you are worried about your heart health, Brown says, “the best thing you can do is see your GP. You can get a heart health screen with your GP every year.”

The Victorian Heart Hospital will be the first dedicated Heart Hospital in Australia and will open in February 2023, in Melbourne.

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