Are Heart Attacks Sexist?

Can a disease be sexist? Well, no. Diseases do not “target” individuals. Afflictions do not “see” a person’s race or socioeconomic status when deciding who to target. However, social responses to people with certain diseases and methods for treating the disease certainly can be sexist. 

Heart disease is an all-encompassing term that describes a variety of conditions that affect the heart’s structure and function but was originally only thought to affect men. Coronary heart disease (CHD) is caused by the buildup of plaque inside coronary arteries. It is important to note that CHD occurs more frequently in men but is the leading cause of death for both men and women in the United States(Mehta, 2016). Women are less likely than men to have obstructive coronary artery disease and far more likely to suffer complications such as blood clots in the heart’s arteries. One such complication is acute myocardial infarction (AMI), also known as a heart attack. AMI occurs when a blood vessel within the heart becomes blocked. CHD is life-threatening to both men and women. This begs the question: why is a disease that affects both sexes originally classified as a predominantly male disease?

Image result for acute myocardial infarction

James B. Herrick was the first physician to describe and characterize CHD. His work titled “Clinical Features of Sudden Obstruction of the Coronary Arteries” was instrumental in defining the field of heart disease (Mehta, 2016). However, his work contained certain biases which stay with us to this day. Herrick only studied male patients because they were more accessible at the time. Men were more likely to smoke and become obese, both key risk factors in CHD (Ngyuen, 2010). However, by characterizing only men, he also only characterized the symptoms that afflicted men and was mistakenly led to believe that women were not harmed by this disease.Unfortunately, this perception that CHD is a predominantly male illness has stayed with us today.

Image result for female symptoms of heart attack

The symptoms originally characterized by Herrick have evolved, but they are still mostly characterized by what men suffer from. It is also important to understand that men and women suffer from slightly different symptoms. The two most common symptoms for men include angina (dulling chest pain) during physical activity and breathing problems. Women can suffer the same symptoms as men but also have an entirely different set of symptoms: angina during resting or sleeping, the location of pain is more likely to be in the neck and throat and be described as “crushing,” mental stress, nausea, vomiting, shortness of breath, abdominal pain and sleep problems(Mehta, 2016). An Internet search for CHD symptoms lists women’s symptoms, if mentioned at all, only after men’s or under a separate section. While one could argue women are less likely to have this ailment, this is incompatible with the fact  that women are 50% of the population and die from this disease at a rate greater than that of their male counterparts. In the case of an AMI, it is important to receive immediate medical attention. This is because the cardiac tissue of the heart is not constantly being supplied with blood and will begin to decay. A review article found that elderly women who are suffering from an AMI wait up to 37 minutes longer than men to seek medical attention (Nguyen, 2010). The delay of seeking medical attention is one of the major reasons women have higher morbidity rates in the case of AMI (Ngyuen 2010). While the precise reasons for this delay aren’t known, it has been suggested that women do not seek medical attention because they think they are not suffering from the “typical” symptoms for a heart attack. Some women claim they did not know they were having a heart attack as they were unable to diagnose themselves since their symptoms did not match those widely reported (Treato, 2018). The failure to communicate that more symptoms exist than those that commonly experienced by a man suffering from AMI shows the inherent sexism of medical officials by dismissing the symptoms of 50% of the population.

Defining the symptoms predominantly by what males suffer from has even the medical community misdiagnosing women who suffer from CHD at a high frequency. Many of the risk factors for AMI include age, smoking, and obesity. This leads to many physicians believing that young, healthy women cannot have heart attacks. According to Swedish data, women suffering from AMI were three times more likely to die in the twelve months after their heart attack than male patients (Thorpe, 2018). Women were also 34% less likely to receive surgical interventions, 24% less likely to receive preventative medication, and 16% less likely to receive blood thinners (Thorpe, 2018). Part of the reason lies with a misdiagnosis on the part of the physicians. Misdiagnosis, treatment upon arrival, and time for proper diagnosis also varied significantly within US systems (Hani, 2008). However, even when doctors in Sweden did properly characterize the ailment, they were far less likely to prescribe the appropriate treatments (Thorpe, 2018). Whatever the reason, women were not receiving the same standard of care as men, even when known to be suffering from the same affliction. This standard of care differential can be attributed to nothing but the inherent sexism that has long characterized treatment of CHD. 

The gap in standard of care is one of the major reasons women, despite being at overall lower risk of AMI and CHD than men, die at greater rates. 26% of women will die within a year of their first AMI as opposed to 19% of men (Mehta, 2016). Within 5 years, 47% of women will die while only 36% of men will die (Mehta, 2016). Even after proper diagnosis, women have higher in-hospital mortality rates (Mehta, 2016). 

The undeniable bias and sexism in treating women who suffer from CHD and AMI leads to the death of thousands of women every year. A systemic problem deeply rooted in our treatment of patients and how we perceive symptoms will not have a simple solution. To undo years of misinformation, it will take years of proper education and awareness of the dangers that both men and women face for CHD. It is also critical to reform the resources we already have; to ensure that women and their symptoms are included along with those which men experience, not as an afterthought. Only through vigilance and proper education can we hope to undo deep-seated systemic issues such as the sexism faced by women suffering from coronary heart disease and future deaths.

Edited by Bushra Rahman

Placed by Sri Ponnazhagan

References

| National Heart, Lung, and Blood Institute (NHLBI). (n.d.). Retrieved March 2, 2020, from https://www.nhlbi.nih.gov/health-topics/ischemic-heart-disease.

Heart Attack Symptoms in Women. (n.d.). Retrieved March 2, 2020, from https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women

Garcia, M., Mulvagh, S. L., Bairey Merz, C. N., Buring, J. E., & Manson, J. E. (2016). Cardiovascular Disease in Women. Circulation Research, 118(8), 1273–1293. https://doi.org/10.1161/circresaha.116.307547

Keteepe-Arachi, T., & Sharma, S. (2017). Cardiovascular Disease in Women: Understanding Symptoms and Risk Factors. European Cardiology Review, 12(1), 10. https://doi.org/10.15420/ecr.2016:32:1

Lau, E. S., O’Donoghue, M. L., Hamilton, M. A., & Goldhaber, S. Z. (2016). Women and Heart Attacks. Circulation, 133(10). https://doi.org/10.1161/circulationaha.115.018973

Mehta, L. S., Beckie, T. M., DeVon, H. A., Grines, C. L., Krumholz, H. M., Johnson, M. N., … Wenger, N. K. (2016). Acute Myocardial Infarction in Women: A Scientific Statement from the American Heart Association. Circulation, 133(9), 916-947. https://doi.org/10.1161/CIR.0000000000000351

Miller, P. (2016). Women and Cardiovascular Disease: What Can Health Care Providers Do to Reduce the Risks? North Carolina Medical Journal, 77(6), 406–409. https://doi.org/10.18043/ncm.77.6.406

Nguyen, Hoa L., Jane S. Saczynski, Joel M. Gore, and Robert J. Goldberg. “Age and Sex Differences in Duration of Prehospital Delay in Patients With Acute Myocardial Infarction.” Circulation: Cardiovascular Quality and Outcomes 3, no. 1 (2010): 82-92. doi:10.1161/circoutcomes.109.884361.

Roberts CS. Herrick and Heart Disease. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Available from: https://www.ncbi.nlm.nih.gov/books/NBK714/

 Thorpe, JR. “Women Are More Likely To Die After A Heart Attack For An Infuriating Reason, Says This Study.” Bustle. December 17, 2018. Accessed April 07, 2019. https://www.bustle.com/p/women-are-more-likely-to-die-after-a-heart-attack-because-they-dont-get-the-care-they-need-the-reason-why-is-sexist-7844326.

Treato. “”I Didn’t Know I Was Having A Heart Attack”: Treato Examines How Women Are Experiencing Heart Disease Online.” PR Newswire: Press Release Distribution, Targeting, Monitoring and Marketing. June 29, 2018. Accessed April 07, 2019. 

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