Heart disease is the No. 1 killer of women, but the research has long favored men

By Emily Dwass

May 23, 2019 3:05 AM PT

During a recent and engaging presentation for patients on Medicare, I received a pamphlet listing crucial tests for people of a certain age. One recommendation rattled me: Men from age 65 to 75 who had smoked more than 100 cigarettes should have an ultrasound to rule out an abdominal aortic aneurysm. As a teenager, I did my share of stupid things, including smoking. Shouldn’t women be screened too?

This felt like one more sign that medical bias is still seeping into women’s healthcare.

For most of medical history, the cells, tissues, animals and people studied in scientific research were male. Women have long been underrepresented in clinical trials to evaluate treatment and outcomes for abdominal aortic aneurysms, according to the Journal of Vascular Surgery.

While these aneurysms are four to six times more common in men than women, rates for females increase with age. And when a postmenopausal woman develops this type of aneurysm, she is at grave risk from dying of a rupture. (An abdominal aortic aneurysm is a swelling of the aorta — the blood vessel that supplies blood from your heart to the rest of your body. If it bursts, the bleeding is often fatal.)

For most of medical history, the cells, tissues, animals and people studied in scientific research were male.

What’s more, women over 65 who have heart problems or a history of smoking have elevated rates of these dangerous aneurysms. Some experts believe that women who have those risk factors should be screened for the condition.

Heart disease is another issue that illustrates the gender divide. It is the No. 1 killer of women but many people — including some doctors — are not aware of women’s unique cardiac risks and symptoms, which is a “very serious issue when women seek emergency medical care,” said Dr. Alyson J. McGregor, director of the Division of Sex and Gender in Emergency Medicine at Brown University. For instance, women with heart disease may not have chest pain but instead experience shortness of breath, fatigue, sweating, back pain or indigestion.

Female heart attack patients typically fare worse than men, with women of color facing the greatest dangers, according to a 2016 “scientific statement” by the American Heart Assn. It also noted that cardiac disease in women remains underresearched and undertreated.

For a book on the healthcare challenges women face, I interviewed an athletic Latina woman who suddenly experienced fatigue and shortness of breath. The diagnosis was asthma. When she was finally granted a referral to see a cardiologist six weeks later, she ended up being rushed into surgery for a life-threatening artery blockage.

The type of heart attack she had is known as a “widow maker.” Perhaps it’s time to come up with a new name for this killer.

On her own, this woman discovered that a serious pregnancy complication — preeclampsia — she had decades ago might have triggered her crisis. Her cardiologist was unaware of the link, despite research showing that women with preeclampsia, characterized by high blood pressure and organ damage, should be monitored for cardiovascular problems. Not that long ago medical students were taught that preeclampsia posed no long-term maternal health risks.

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I recently became concerned about my own cardiac health, when my LDL — or “lousy” cholesterol, the kind you want to go down — spiked, even though I watch my weight, walk more than an hour each day and eat ice cream only in my dreams. High LDL increases cardiac risks, and patients are advised to focus on diet and exercise as a first line of defense. But consuming more oatmeal or adding steps to my daily tally might not make a difference because of a looming risk factor: Strokes and heart attacks are prevalent on my family tree.

I wondered if the cholesterol-busting statin that works so well for my husband would do the trick for me. Until relatively recently, male participants outnumbered females in testing of statins and the drugs’ effectiveness in women is up for debate.

Thanks to the American Heart Assn., advocacy groups and scientists pushing for the inclusion of sex as a biological variable in medical research, real progress is being made in women’s heart health. But one ongoing threat involves doctors who don’t always listen to women or believe them when they are describing their symptoms. This can have disastrous consequences. Despite advances that have been made, the greatest tool women may have is to advocate for themselves and to ask questions such as: What tests should I have to rule out a serious problem?

As for me, if my next LDL lab results are still lousy, I’ll ask — correction, I’ll politely insist — that I be referred to a cardiologist.

Emily Dwass is the author of the forthcoming “Diagnosis Female: How Medical Bias Endangers Women’s Health.”