Just in her mid-50s, another wife of a long-time patient of ours suffered a heart attack recently. She has been diligently attending to the health needs of her husband who is 12 years older than her. Never did she complain of chest pains or any symptom that would suggest a possible heart problem. Then, it happened suddenly one early morning just as she was about to prepare her husband’s breakfast. She felt a tight squeeze in her chest with shortness of breath. She was having cold sweats although it was relatively cool in their house just before sunrise.
When brought to the emergency room and told she was having a heart attack, she was incredulous. When we personally saw her later in the morning and confirmed that she really had one and needed to be confined in the hospital’s Coronary Care Unit, all she could mutter was “How come?”
Frequent experience
The case of our patient’s wife above is a frequent experience. Many times, a doctor would be closely monitoring and treating the husband for heart disease only to learn later that the wife has succumbed to a heart attack or stroke or even sudden death.
All the time, the wife has been accompanying her husband to the doctor’s clinic and the doctor never bothered to remind the wife to have her cardiovascular status checked, too. And we plead guilty to this passive neglect frequently committed by physicians. It’s regrettable when we lose the golden opportunity to diagnose and treat unsuspecting wives before they develop a serious cardiovascular complication.
There is still a prevalent misconception, not only in our country but worldwide, that cardiovascular disease or CVD is a men’s disease and women are considerably spared from it. Research data would now show that this belief is diametrically opposed to the real fact. After the menopause, women in general tend to have a higher cardiovascular risk than men.
CVD is the leading cause of death in many developed and developing countries and was shown by research data to be responsible for twice as many deaths in females than all forms of cancer combined. And yet, we have what experts call as the “bikini” orientation when it comes to women’s health, wherein the focus of the average physician is on problems involving the breast and reproductive organs, somewhat neglecting the other parts of the body particularly the heart and the rest of the cardiovascular system.
Top killer in women
For quite a time now in our country, CVD is the top killer in women, as it is for men. Diabetic women particularly have a much higher risk than men their age to develop serious heart disease, have a second heart attack and die from it, or develop heart failure. The Philippine Heart Association has an active committee which tries to raise awareness on women’s—particularly postmenopausal women’s cardiovascular health and how serious complications could be prevented.
There are differences in the men’s and women’s bodily makeup. Before menopause, the women’s cardiovascular system is somehow protected by the female reproductive hormones particularly estrogen. But as the estrogen level progressively declines with age, this natural protection is lost and makes women even more vulnerable to hypertension, heart attacks and stroke after menopause.
It’s only in this decade that cardiac research is focusing on women more than it used to. For the longest time, research has been done either exclusively on men, or with women represented in statistically insignificant numbers, says Dr. Sharonne Hayes, director of the Mayo Women’s Heart Clinic in Rochester. She elaborates on this skewed research imbalance compromising optical care for women: “In the 1960s, erroneous assertions that heart disease was a man’s disease were widely spread to the medical community and to the public. This led to research almost exclusively focused on cardiovascular disease in men. Many clinical trials in the ’70s and ’80s excluded women or simply didn’t make an effort to enrol women in sufficient numbers to draw sex-based conclusions.”
Now, researchers are recruiting more women into clinical trials and they’re analyzing research data by gender also to determine separately the risk of heart complications in women, and note any disparity in the behavior or responses of women to standard treatments or interventions. In a way, the expression that men are from Mars and women are from Venus may make some sense in conveying the message that women’s bodily systems are not exactly like a smaller version of their male counterparts.
Foreign and local heart experts are also concerned that women are getting short-changed in terms of getting optimal treatment for their CVD, because they are being afforded less than men the benefits of modern therapy such as optimal treatment with best-of-care medicines, angioplasty or by-pass surgery to improve the circulation to their diseased hearts. Physicians and other healthcare practitioners have to shake off the wrong notion that one has to be more aggressive in treating cardiovascular disease in men, but not so in women. Getting rid of such gender bias can save a lot of women’s lives yearly worldwide including the Philippines.