Did you know that heart attack and stroke are the number one cause of premature death for women in Canada? Or that Canadian women are five times more likely to die of heart disease than breast cancer? Or that 53 per cent of women who have heart attack symptoms go undiagnosed when they seek medical treatment?
It's "stunning" facts like these that Canadian cardiac researchers are hoping to get across this Valentine's Day weekend with the Wear Red Day campaign.
"If you ask Canadian women what they are afraid of, they will say breast cancer," said Colleen Norris, professor in the Faculty of Nursing and chair of the health systems and policy working group of the Canadian Women's Heart Health Alliance, which is hosting Wear Red Day.
"The whole idea of Wear Red Day is to get that conversation about women and heart disease going," said Norris, who is also scientific director for Alberta Health Services' Cardiovascular Health and Stroke Strategic Clinical Network. "Tell all your women friends!"
Norris pointed out that while women have worse outcomes from heart disease than men, two-thirds of cardiovascular research is focused on male study subjects. That's why she recently led a project to review all of the existing evidence about women's risk factors, disease awareness, presentation, diagnosis and treatment in the Canadian Women's Heart Health Alliance ATLAS.
"We can't move forward unless we know where the gaps are," said Norris, who is also a member of the Women and Children's Health Research Institute.
Recognizing the signs of heart disease in women
Norris has just begun a new research project of her own tracking the number of women who present at emergency departments with signs of heart attack or stroke and are sent home without being diagnosed. She said her initial research found that between 2010 and 2020, 300 women per year were discharged this way from Alberta hospitals, only to return with a full-blown heart attack within 30 days.
"The big message is that it's not in your head—no matter what age you are, you are just as likely to have heart issues as men do."
"These numbers are just horrendous," she said. "And they don't include the women who died at home."
She said the signs of heart disease may be different for women than men. Instead of the "Hollywood heart attack" symptom of extreme chest pain, women may experience only chest discomfort, sweating, nausea, shortness of breath or light-headedness.
"The big message is that it's not in your head—no matter what age you are, you are just as likely to have heart issues as men do," Norris said.
A heart health passport could help
Norris said the Canadian Women's Heart Health Alliance is building education modules for medical and nursing students, so they can identify and overcome the biases that may lead to them missing the signs of heart disease in women patients.
She also proposes developing a "heart health passport," which would list a woman's medical history as it relates to her heart, so she could discuss prevention with her doctor.
"Women who have had prenatal complications such as gestational diabetes, hypertension, pre-eclampsia or protein in their urine are at significantly higher risk to develop early heart disease," Norris said. "Getting pregnant is the first stress test you will have—it really taxes your vascular system."
"Identifying women at risk early in their lives means that it may be possible to alter that risk," she said.
Norris said recent research has also uncovered that women are more likely than men to have microvascular disease in the tiny vessels underneath the main heart vessels, which can't be detected with current scans. "We don't yet know how to diagnose it or how to treat it effectively."
Arming women with information, good questions
Norris said that along with biological risk factors, women are also affected by barriers related to their gender roles. For example, while there is a general trend for people with heart disease symptoms to delay going to hospital during the COVID-19 pandemic, women are even less likely to seek treatment.
"They are busy as front-line workers and caregivers, and they delay going to hospital for their heart symptoms because they're afraid of getting COVID," she said. "But they also don't want to bother emergency staff who are dealing with the pandemic—women don't want to bother others."
In other U of A-based research, it was found that women may not seek treatment or follow up with prescribed rehabilitation because they feel embarrassed that they became ill.
"The word on the street is if you eat properly and exercise enough and take care of your stress, you won't get it," she said.
Norris said the solution is to ensure public health messages show women how they can improve their health, rather than making them feel guilty.
She advises women who do go to emergency for heart disease symptoms to ask the following questions before they leave:
- What do my blood pressure, electrocardiogram (ECG) and other test results show?
- What are my risk factors for heart disease?
- Where can I follow up if I have questions about my heart?
- What should I do when I feel symptoms again?
"We can give you the tools to be strong and advocate for yourself," Norris said.
