MY TAKE
A GIANT STEP FOR WOMANKIND? MAYBE NOT JUST YET.
Do we really need research to tell us that “Women’s bodies are not the same as men’s – and neither are their lives?” Image credit: RHYTHMIC CREATIONS on Unsplash.
By SHAGORIKA EASWAR
My neighbour and good friend Dorothy often talked of the not-so-good old days. Of the times when they used to store root vegetables, squash, cabbage, and even apples for winter in a pit dug in the yard that was lined with hay.
“I’d go out in the depths of winter, brush the snow off the top, remove a layer of hay, and bring in the fruit or the vegetables!” she’d say.
Dorothy, who passed away at the age of 86 some 15 years ago, also talked of the times when women’s health issues were dismissed as “Woman trouble” or attributed to “that time of the month”.
Since time immemorial women’s health has not been given due attention. Shockingly, in spite of studies that show women are impacted differently by diseases and that they respond differently to medications, they were not part of research studies until recent years.
Last month, Heart and Stroke released a new report revealing the significant inequities that put women’s heart and brain health at risk. According to the report, heart disease and stroke are the leading cause of premature death in women but gaps in research, diagnosis and care, often compounded by intersecting and overlapping factors, threaten women’s heart and brain health.
The report, System failure: Healthcare inequities continue to leave women’s heart and brain health behind, touches upon the following:
• The persisting lack of awareness and understanding around women’s heart and brain health.
• Nearly 40 per cent of people in Canada do not realize that heart disease and stroke are the leading cause of premature death in women.
• How women face distinct risk factors for heart disease and stroke – and at different points in their lives, including pregnancy and menopause. But only 11per cent of women in Canada can name one or more of women’s specific risk factors for heart disease and stroke.
• How gender roles and social expectations can create further barriers. Women tend to prioritize the health needs of their family over their own. They also earn less than men on average, take on greater caregiver responsibilities and have more challenges advocating for themselves. Women are less likely to participate in cardiac rehabilitation programs than men and are less likely to stay in the program.
• How many women face further risk due to intersecting and overlapping factors such as race, ethnicity, Indigeneity, socioeconomic status, sexual orientation, geography, body size, and ability. Research shows that South Asian, Afro-Caribbean, Hispanic and Chinese North American women have greater risk factors for cardiovascular disease.
The reasons for these inequities are varied and complicated, but these inequities exist across society and have been ingrained in the healthcare system – and they need to be dismantled.
Two-thirds of participants in clinical trials on heart disease and stroke have been men and when women are included, a sex and gender analysis is not always done.
Many of the tests used to diagnose a heart attack were developed and tested on men and many guidelines for heart disease and stroke still fail to adequately address women’s needs.
Do we really need research to tell us that “Women’s bodies are not the same as men’s – and neither are their lives?” But then we are living in an age where we are informed that “Men and women typically have different communication styles, and research shows that men’s voices are considered more authoritative”.
It comes as no surprise then, to learn from the report that half of women who experience heart attacks have their symptoms go unrecognized. As well, women who experience a heart attack are less likely than men to receive the treatments and medications they need or get them in a timely way.
Heart disease and stroke claimed the lives of 32,271 women in Canada in 2019 – one woman’s life every 16 minutes.
In 2019, 20 per cent more women in Canada died of heart failure than men, while 32 per cent more women died of stroke than men.
Elderly women are exceptionally touched by stroke: they are the most likely to have a stroke, their strokes are the most severe and their outcomes are the poorest.
Dorothy could have told me that. In fact, she did. “No one wants to listen to little old ladies, honey.”
The good news is that research around women’s heart and brain health has increased and more research funders require sex and gender in research design, analysis and reporting.
Women-specific considerations have been incorporated into more heart and stroke clinical practice guidelines.
There’s progress, but not enough and the consequences are stark.
So please don’t look askance at us if we admit to feeling out of sorts just because you can’t see an obvious cause. Don’t ask us to “Stop acting like a girl/woman”.
We can’t help it, it’s hardwired in us and now, finally, science is recognizing it.
SIGNS TO WATCH FOR
Women face distinct risk factors for heart disease and stroke at different points in their lives and can experience different signs and symptoms of heart attack.
• Use of some oral contraceptives increases risk.
• Pregnancy can lead to hypertension and gestational diabetes which increase the lifetime risk of heart disease and stroke.
• The rate of stroke is three times higher during pregnancy than in nonpregnant females of similar age.
• As estrogen levels drop during menopause, the risk of heart disease goes up and hormone replacement therapy can increase risk.
• As women age, they acquire cardiovascular risk factors at a faster rate than men.
• Some traditional risk factors which increase the odds of heart disease or stroke for both men and women have a greater impact on women including smoking, high blood pressure, diabetes, obesity, physical inactivity and depression.
• Gender-affirming hormone therapy puts trans women at increased risk for stroke, blood clots and heart attacks.
• Women are more likely to experience discomfort in the neck, jaw, shoulder, upper back or upper belly; shortness of breath; nausea; or vomiting than men.
• Most women experience more than one symptom, yet men are more likely to simply report chest pain.